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FOR OFFICE USE, AMIWTION POR SANITATION PERA T ....... . ....... ..............._. .......... FrrmhNe _T_. 'p ICs mpg N M TtPtsetel Two Perturb ExpiresT year From Dab Isseed Dols teethed 7� Appheolbn is hereby made to Wes San Asoquin Local lbalth District for a permit to construct and Insron the Week Moab .This applloellen is mads in compliance with County Ordinance Ko. 549 and axis" Rule and It mAx110rtel J65OUTION .. /sos�......E...A...11�� e0.__!I�/.....R.%�o.N.....cEFallS TRAtr _...... _..... Owner's No" ........Y.�tsGQr.►%cs.�� s...._............................Pba» ..i"n...vf^—...'_ .. Addressd_ ....... _.....___..._cityAo..0._... GAT":. .... .. ................... Cohtroctor's Name ... ;^Y rh..oP.,r.,y..... O.,(AIC:s . Phare kutanMbn will .rye% Rnidrt, OffApeAmud NomC3 CaMwnlal OfroRer covet O MGM O 011ie...... __..�.»»...._._... Number of (lying unit_ J.... Number of bttdtaA ._I—Garbage GrIndsr ...tKS... Lot Sin ..ei?, c--`1.............. __ War Supply, Public System and name ------------- _............_....hlwN Character of soil to a depth of 3 f00% Sad M Sib O Clay O aa►O Sandy Loam O Clay Loom O Hardpon O Adobe O Fill Motrbl ............if yes.lyes ............ ............ IMM plan, showing sin of lot, location of system In elailon to wens. buildings, e►c must be Placed an WWW" (Ade.) NEwyWALLATIONh Rro septic tank or e«page pit pw do if public rawer is aveiksblo w1thk 200 fosoll PACKAGE TREATMENT ( ) SEPTIC TANK[ )He rJ/Ar� Slss_/�Oj O.C1..._.........._............ LIquW Dev. ..._..... Capacity /Q.00�.... Type CtjrhOe txf . Material..._................. No. Canpatme+M Distance to nearest, Wet ._/GLl..t..._-----.-_...fohehdatbn ...................... Prop. Line._... .. _ .� LEAQI11140001 LINE ( ( Ne. of Lines . ._. ...._..... __. Length of each tiew _ _.._..... ... . .... TOW Length ..._._...».».� _ O 'D• Box ...... .. Type ether Material ......... .........Depth Filter Material .......................»..»_....» ».�1 Distant to neores% Well - .. .............. Fastdatien . . ... ..._ Property Lim ............... SEEPAGE MT ( I Depth .._ . ..... Diameter ..........__ Nhtnhber _.. . .. .. ..... ..._. Rack `(lied Yes O tett O In Water Table Depth ____........Rack Sin ................_.............. s Distance to near"%Wen ....................... fohxhdMlon .................... ►sop. REPARI/ADDITION(Prev. Sanitation PWmIt dl .---..........................__._... Dob ...__.......... n /er .4r I.I« . .. ./.1��'C%.4.d!'n ......1<<!1.�. ... .... ^� Sepik Tank Opecify RegUin^»^ 1 ...............». . Disposal Field (Specify Requirernenh) .»...4..N...a�.!iTn�'.......,Sf7.•c.....7A/r.#y...... ........... ........._........ trW ..................................._.........._......... I . ......... . ....... ._.................. ..........._..............--- (Draw sxisNrhq and required eddNbn an revrN tidal ( 1 hereby terN/y that 1 have Prepared this aPP"Weiem and that " werk wM M done 1" acserdaece vA* Sea Agela I Cow" O'n ow", Ste% Laws, and Rules end btvla"ns of ow Sea JeaRulm Loral Ned& Dktrkt.Nerve ower or Now sed Stem%signature cerMfles Act Follow no: Ploy ally ►coon M shtath ateSSw "9 certity Owl In tat rn perfeemence of the Work far which A% per" Is Issued, I she" set e " to became svblM to Workman's ComPetsaNan lacers of Csnf*r*ha" S9pned E. A,M r/lO n'� ? SON .. ._. ........... . . Owner By .�/� ._ ... . . . TBIe �iTatherh marl , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By DATE BUILDING PERMIT ISSUED DATE ADDITIONAL-SPAM NIS -j J� /J Final InrpecNan by Date JL./t • ` ��f - E31 13 2h 1-611 ;a'I JOAowtl 10'AI WALIH DIVOICT 8/7h 3.4