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FOR 0 USE:
<br /> R # 14 VA W
<br /> .� i�,1,tlatel Pernnit
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<br /> A0plicatian"to hereby,made to the;Son Jcaquj#t-16cal"I Ctlth District for permit to ctinstru�t.o # S II work herein' � , .
<br /> described, This applotion is rr�ciele in cc mom+ r �! rd na No, �+�9
<br /> JQ8 ADDRESS/L T� ' -- ..w,.y b, - +
<br /> Owner's Name w w t -...
<br /> Address ' -- �' , .CIS `` �` .M
<br /> Contractor's^Name i ! ..Ucenme
<br /> Contractor's :rt PW hw.
<br /> Installation will serves )trlsldance( er t•Houea ptC0Mme ial OTrailer hurt ,
<br /> Motel01101f r ._ :..
<br /> Num of living units __ _ . .t4iim, sr of bed r s, .e Grinder L� . � �..>...
<br /> Water Supply. Public System and.tarn '
<br /> Character of soil to�a depfi f 3 feet: Sand-t Sift l -Clay•,j y Nat 0, 5dndy` rnr: ` �+ay>Loarn�j
<br /> Hardpat j /done Pill'lal tarlat If
<br /> (plot plan, ahowinge'.sift:of.lot,_#ocatton �"�Y i�'ra#atit+n t0 We11S, buildtngEr .;+est be=�#ac tip: 1W, ele
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<br /> I�1LMl IN ALLATII�I�t� .1No.se t:tank-a`s� opoge .fit tI`PWA-
<br /> PACKAGE fREAT1 IElVT EPTIC TA#l
<br /> -Capacity _ type
<br /> Distance to nearte : .Well _ _ __ .,.. Foghdot#on
<br /> LEACHING LIME [:� N©.: of Lines LengXth_of edch line T
<br /> 'D' Box . Tlrpe ilt Mt erlal ..Depth 4#er
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<br /> Distance to nearestz Vie# .......................Fcrttndgtlap_ _____,.v_, !Y._> rtyJ lJFte�
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<br /> SEEPAGE:PIT Diat, ter` - >.. Ntier .- - - `! etw '�►
<br /> Water Table Depth _Rack Size
<br /> Distance to nearest: Well --------- -- ------ --- _._..:.._.... Ptd. Llrte;:..,,
<br /> iRRPAtR/ADDtTUMPrey. Sanitation Penit# .)
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<br /> Septic Tank"(Spkify Requirements) ---. ..... _. -.>-. ,,, », ,,, Yr . .,,,,,.. ,
<br /> Disposal Id (Sped Regyir
<br /> _T_V'iI_ ___ _ - -. .r. _ ,.�r- _ -♦
<br /> -' (Dray exisol awl regvirod addition on reversesided -
<br /> i hereby certify a:1' have p mowed tills appNli ,a14*01 the,:work will dt= enw► do,fi.
<br /> --Cavnty,Ordinanc�es, Stat lawn, and Rolesand
<br /> ef tha Ilan min LoaaF
<br /> Sed agents
<br /> signatwe cartifi" fatbvring
<br /> "1 ce"Ify that in tb*p�t0far�Velilm weAlor tAAA this permlt is isswd, 1 Sh+atl
<br /> a s to become Sub(ect!e Cemp tion lam E'�ilifo �a."
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<br /> (if other than awned =
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<br /> Alf# .U#E OMLY
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<br /> APPLICATION,A VTEt3 61( _ :_ I fi n
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<br /> ADD ITIC�NA1 T ........ a !
<br /> CC t l+l -.. _... . .r„-. ♦.. ...r.. «.. ..,.,....i .6s... ..a.. .---- k L Yrs b -ir fV YawMMY 1 .,w+Y�
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<br /> 1t JpAQUTAt LOCAL HATH DISTRICT
<br /> . H. 9 I-'dS Rev. $M
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