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<br /> FOR or:Fyb U5€. - -
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<br /> APPUCATION FOR SANKAPON iPERIM
<br /> IGernplei;riRau TrFplleohl
<br /> Fhts rondo Ewptras,7 kMaa frarnu atrly�uad !)asv Raotd✓ '„ ....
<br /> At.+ylltatid/r I!hereby Made to the Sam aaaquln Local'lidoith DI►*id for o pervoTif to' toomtud ani insledl tke wafk heralh
<br /> detari6ed.Thi!appliaxitian Is nada in geattp[lonm witf)s Gaunlye Ordtrtsm No, 544 and exLrhimg Rales and Ruqulatfmlt r
<br /> FIr
<br /> JOB ADDRIESSR�1ilON ..-�„yI._,'4: a?�...:�.} ,e.... ,..i 41J6 TRAuCT Owner's Noma .,...--..... CSS ld R`_.,I r¢r4 s..... ........................ ..........................dhea[e
<br /> Address ............................... lv*k t..... 'fir..._.........city ,..5'hCsc l ,rte+�F'................._.._1...............•........... 4
<br />� Cemursder'e Nernie.�.-.....�`-}s.�.�,,.�ltf?r?d�A�...�.�t�k:�.......... .........lieantio#a .�--+'¢�.�. ..PErane.��'"• �'.�.
<br /> tnoollation will ieroe:- Resldento Elf4parfinemh wouse0 Cm"t tteetal oreallof 6urt 0
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<br /> y � I1Aotal�aJthar........ ....:.......... ...-,..,-,.....
<br /> Nanshet OF living urylls_,..._,.,., Number of $frit&F , to
<br /> +Nazar SuppEy.P41131iC5Ysfam qnd rtalrne.._....._.._......_.. -._.,_... ....,.. - .PYii6'O K I
<br /> FCdharwer 4 toil to a depth eP 3 featE. Sand I3 Silt[] Clay d peat a sandy loam p Ciay L6aee�0
<br /> ,r,:,.,;— �,...�.► .; HardpenAdo�aJ[��Fll@
<br /> r INvt Plan showing Ole of Ivl.-INgrion of sYsf m.Fn.f*I*r1o.n I&wef i,buildings. etc. RWO he Plaaed cat r�rta time.)
<br /> F*; WN INSTALLATION: Oft septic tpnk or senp"e pat perm'sttad#t public tovw&r is available wf*leh 200 fact ji
<br /> PACKAGE TREATMENT f] SEPTIC irmx Slma.....�e � y� .Rf, 4Egv+d f3apth ..... .... J
<br /> Capatclly �" ,�.'�, ryx �f,4ab.�`_`
<br /> Dkstanee to eswest: W01 ................ ,....FCs"N.:,.lrrap.Pane. --'�'-----
<br />' F- LEACHING LINE f l Na. of Unca -. ,: ..... L.T1h of.each-lima---.10%!�6.------..- Tafat Umsth 'vZRM*.......
<br /> TIP
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<br /> 'LF tib>< :J,: , typo Filter Malarial �:,._...Delrth Irifdar Akasl+trlatl ,.,f.,.�... ........ I
<br /> LirTsoncv Ia aear�esf, WeE[ __..----.�+_.`.�`.... Patmsdati
<br /> 546Pa�PIT [ ] beplh .. m.-_..- DiantlNaa _ . „ .. I�yn.bar ._- ....-.-_.. . [iacls F'Itad tlmt ] INtY�
<br /> I L YYa1rtr Table i hR r rc ”
<br /> pt ............. ..............totj said.._ '_1�r._..f.."`. N r
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<br /> oistonea fo-nearell_Well ,,..,..F��_.¢.......:.:......Fdaadietidss _....I��.�.... Prop. lima ...id.....,�'....-
<br /> G RE?l6LRIIrC�ITGONLi dv.50r111afi4ri PtleAYitsF' lisps
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<br /> 515ptic Tank lMquirrmetyiti .......
<br /> ..:.:.. .:,,. ..... ......,..-..................................... . ..............
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<br /> t Disposal Field §p=ify Requift"Ienlej .........
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<br /> I : ........ ....... -,....,_.._.._............._......._...:..... .-.,:.... ._............,. . ...... -
<br /> _ ••• - '-�+�" FDra�VerGffintij�lrKkiEeEQiltlBl�ddifigilanfdneetitse
<br /> + tI hereby mOily that I laude pte paced this a6t Reatlan amid fhat the +creek W1I11 be if6wo toe aacatdlis" w"%I" a'OKU16 I
<br /> County Oralamusbm,5%tv Lem,4ew tiyelei and leptnledam af'the San Jeagaim,LwAt l OUMN Bl'040.Il4ote Wwner Of React �
<br /> 1 d attaaft tlpaahrrta"fNCtes ft W11N tm9e
<br /> "I w"Or Ihot 1"rlr*parfbe+ecm"ef�rh*We&ter with Ihlt permlr it ladwoal.L jhOR Mo.*"Jay arrr peOVaat ta,NW&nsatrl Of I
<br /> as to boom*tubi et is wwkmare t Campaasallon[www of t allfatda",
<br /> r Signed..,... .. .............
<br /> .: .........own
<br /> @J et
<br /> NY ..4T... �ti e .. ..... ........ ... ..... ... i
<br /> Of olfier Than etwnerl e{
<br /> AEPL1t:ATicw ACCEPTED ay...... .............UP4TE:. d,- 'e.".rf a/.. ....... 1
<br /> guiLDING P6RMJT IfA'AID :, DATE....
<br /> .............................. ._..._.._.. .................................
<br /> ' A17i71FItl L''OMhl4EhiL5..............�!.,..,..,..,.,_:,,.,......,.,.,,..,.,.,...,,-•---�--�............... ........................ ...............,....:.. ----.---.
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<br /> FInaGlnspet:tioa 6frr._. ...........:.......... ..:...... .........................
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<br /> 5+ttV AOAt',TUtN LOCALt1t:ALYIw OWN= fr
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<br /> 717139
<br /> Fr NOTEXTPAGE
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<br /> 7/8/2014
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