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<br /> A��
<br /> i •
<br /> FIL
<br /> i 6z C 0 P.
<br /> FOR OFF U'r, .IC ON FOR SANITATION
<br /> .. j nrl�'c'l CATION "EMIT
<br /> tComPlate In Triplltafef
<br /> 'K141P^fl 1
<br /> W i l,ls f emslt ExPtret I.Year From Date Iss+:red
<br /> Application ;s hereby mar:lt, to tlt^ Sc!-, Jn0nvin Lnrnl Ne,allh District for a pe:m'I! to construct n••.s 'n;!r," herein
<br /> described. Th,s naplicotitn ;o,ortrpnce +m;fh COVnty Ordinance N:3 i,!? end es-is!inn r; fe^r F.rgLf!c,'iCny: ;a:
<br /> JOEL ADDRESS/1,0CATr-)ti r�l�t C C.!AT£ec.�,V I G Cc45 r p`C" F
<br /> Owner S ,ir,rnn
<br /> C.iry
<br /> C*r%tfaCs,nr 5•Nor"r� � i� t-r"..t.,t r—r � -`^rats..,C. l,..y 1 a + o,Yrcr.. t
<br /> Installotion will sCrv�;' . Rrsi }rn[P+ f j &,parTment I'fouse❑l Commercial C)TrailerCourt
<br /> 1tir)lel F10$er 44csp�' ..:�.7t' .t.. K
<br /> Number of living :miss, N,.imbir of bedrooms . ........Garbage Grinder Lot Site }°°4
<br /> Water Supply: Pi,hl;c System rind rti„r,., .;..,,,... rrivate n �(`
<br /> Character of soil to a depth of I Fcvl Sond [ ] Silt L-1 Clay ❑ Peat 0 Sandy Loam U CMay l.oary+
<br /> Adobe Fill Material If yes,type .... .. `;
<br /> (Plot plan, showing sizaWof lot, focarir..n of system in relation to wells; buildings, etc. must bt, f,!acr!d on reverse side.)
<br /> NEW INSTALLATION: {No septic to,t, or seepage pit permitted if public sewer is avaifob;e within 20C fest,)
<br /> PACKAGE TREATMENT [ ] SEPT1r TANK [ ] 5ize...:., 14.. ..:.... LigL=id Dcp•#, �)........:.... : .F
<br /> /' a A
<br /> Caparity /C�4 Type No, Cnfnrorim^nts ......:.. ' S f`
<br /> Distnnce to n^ares: Well �)_. . ................FoundotiOn .- . 7 Prop. Line ...:' ........ �`r,
<br /> ...
<br /> LEACHING LINE [ } No, of Un,cs Length ofEach lln� .�" 7ota1 Length S �
<br /> -x !......7...-
<br /> Ct' Box 6;)-` Type Filter Material I °4.?� X Depth Filter Moteriol l0 t
<br /> I11 ' a
<br /> Wrl3' ?' d .r.:�, tlt]t,' :�4 a
<br /> SCEPAGE F�tY [ Dpt,llt I]inmrtL r r° w :Nuhtber �I Poek Fi[lr_d Yet na t
<br /> Wn1r.r.Tc,i{rr+ rr,lyth �Vrt'ft ���JY.Retck aizA
<br /> +}
<br /> Distance to 11"ormt: Welk �� " t }w i, ,Foundation , CAO. . r. crop, tine .... i
<br /> f4 } Eli ...
<br /> REPAlRf�1Db1TION lf+rev: $uniiatiorr r4•rmit yr/ . ., ., r.,ti . lk�'Jt "L)Cfe }
<br /> Septic Tank fSpucify
<br /> .....:.. . ..
<br /> Disposal Field [Specify Requ4icrren,'s?
<br /> ac i, a? Al
<br /> # E. �+
<br /> Z.
<br /> IIs ,w:„415hng r,rrJ raqu36edlatldill6rron reverse side)
<br /> 2 Gi ,PL 5
<br /> ! hereby. certify Ihat I hove prrf�arrd ll,iK r:pnli<r.tivn nnd_ith`tlt+ffie Wtiek, will be done .in atcarcigrire vrith San !ai't't4
<br /> Caunty-Ordinanc#-f„ Slate.taws, r"Id `vl•+� and tte.�uiac,at_,'sr+�'f lrlsrs 3ojr,donquin lecnl i{iralth blslrtct. Hnm'e nwnur er.litsttt� ;l
<br /> sed agents signature tertifies
<br /> "I certify that in tho parformoricc t:f t[ ^ wrirk for whish ihlsI shallna►'an►Ploy any nersoh in such,mdnrtar „; �- e
<br /> I
<br /> as to beca sibirct to Workmnn'e 4ntn,:,•I,sntinn laws ofsCdlifh ids
<br /> Signed
<br /> y 1 { ✓,
<br /> BY
<br /> {If rasher t�,[Ln o•.:.;,. .: r'' l tsP��" it��` '� �k ,.,
<br /> FOR DEPARTMENT.iL►5ENoNVI'
<br />'i ArPLICATIQtd l�C.(;f=PfF.Ct k)Y ?. r F`,..G�/f i �d r`�tr
<br /> DATE
<br /> f t r"FA nJ t}-+c IIrFY t7 A T f' { t,
<br /> RIJILOII,►r, fIrO1,lT' lfVi.n + s ; a
<br /> AI.NIl0tJhl:: Ao
<br />
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