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<br /> r
<br /> 117
<br /> NO. _ _R 7 A,
<br /> 9 {c.' RErn3 [ ^r. :c. DATE 155UEQ � /1 .11, .
<br /> . �atrpl lcatiph is n_=ri ay •-a4•, •n' •rr. San „0a(4u1n LOCal Nn,I fie•- ; ,+ pr,.•.it to construct an�?or instal? the work herein
<br /> ,described, Sn;1
<br /> apoifca_ -Ade 1r rpr•Tii r.11 xit ta•ru^t, i' iinr.n_P No. 51a for sewage 0r 110. IBfi2 for well/pump
<br /> 'lance 'he Rulet arClI�Pgela7-:J:,^•.'�r. -PSan -Tpn7uin l ,cai ie31 {; c € ek
<br /> lJot: 1dd.ress_�C�i_5� Suu -i- %ar.g
<br /> IE>•+ner'S Name, _��-%4.�1r.�.�GzrEri+iJddre 5 ---'_J7�--_ •�i_Ct rP Phone
<br /> r
<br /> E iContraclor'S Name Gam_ ` + License _ §
<br /> ;r ' '.,1. --._._----------•^•.-•-»�.� Phone
<br /> iITYP[ of KEtt/PumpW :r -
<br /> '.LU WE'LL WELL !+E°L�•CL`•':": _ CE5'c'1CT1O`J L,
<br /> �INS7ALtnTION j OTHER —
<br /> -- - -
<br /> DISTANCE TO N[AGEST• !;t,' ,. T?i,l5 CISiUSa! rLQ. PROP. LM 1.3L'e:'"Ti0'i _.....
<br /> �—_—rtGRICEIi.T'Ua[ 'rJ;:Li, - l?7?E' .+c.Li. T PITS/$LIMPS 4
<br /> i� iNTtNQ[Q USE---------.Y.,,�-`---__..._— _ _.------��--------- -- -.•- i
<br /> 6ELI PROUE�'_.,vEA RU; ^'a ti.=r ii ICA-Y-St�fS E�
<br /> EY] Industrial _1 fprn [iott0r^ ^ant•:a -,. ,. .�r Well rc vatidr,—
<br /> [j%friestic/Pr ivitr
<br /> ack L_ITrar� r loll G+sinq _
<br /> �]T'ublic �0.her - lel to
<br /> LJ Cas,inq `":
<br /> ` irr
<br /> �--J igation _ � iro(rJx. U LaS:er,i -
<br /> Cathodit Protect iRrt Q^-Pth re':i`i<.aito'15 -� � ,,\ •�
<br /> �J GeOphyslCa l ,I 'ia.i,.- Rr rernut :,ea l
<br /> i L:)Other
<br /> 1 u,r'f,,rr Seal Instailed by i
<br /> '
<br /> Rep,1r 1{orl; UonP ivUr, n' tear::, --..--. ft. 5.;rk Doric
<br /> Well lintr;lttion Well Diameter — Sealinq "atrrial (t^:- Jr,': — 110
<br /> Depth - ---- --- fil lnr +aterial (G 1,,,., ,n' --- Y
<br /> TYPE OF SEPTIC WM: NEW ;'.;T•°LL,T10N NT.1:AfR/AGiiiilOr. i`i {'„ -,r;- •.1,;, nr seel,,' nit rermitted if public sewer is
<br /> I available within 200 feet.)
<br /> I
<br /> Installation will Serve Residence _ Cor€e,erc i?1 ;7th,l f
<br /> p
<br /> (lt€mber of living Urlts: N.,, of hedrnem+ - -, - - 'Ve. "+
<br /> Character iif sail to a death:rr feet: _ S,Li •— - - -- -- Water table depth
<br /> SEPTIC TANK + 'yr-rlvf a No. l Departments .2 —
<br /> Gat ��----
<br /> �KG. TREATMENT PLT. L erne?M:9 of nisnosal
<br /> SEWAGE SYST[Ft " P15t0nc,l to nR�st:
<br /> 1rf -47+_•1I r r _ ; _._„•f,.n
<br /> OESTR11CT10N —�C�. a !:i.l•, �{ perty 'tint
<br /> @EACHING LINE s� in. 't Len,,”, or iine5 6 / '-' — '_'a1 ;pngtt°/ rm YD'�_. _--_--- f
<br /> I -.� .l_�__. 7
<br /> F'lt'T[R e[U ----1--- _,c-drti:a ta-nearC':![ Wei 1 h.aPrrLy Linc
<br /> SEEPAGE PITS h Size
<br /> —_----- ---
<br /> :� SUMPG m. tar, rcare',t: �,-II °'''. h...rnrrty Linn '
<br /> DISPOSAL PONDS
<br /> r:
<br /> t hereby certiry t',a .i:':"1;:AtfkM ;tn,1 ;r., ��i. t•, dnnr• tcrnrdanrP withSan ,Inauu:n count,,
<br /> s
<br /> ordinances. sta[n ia. a,i,, tui-, a, .. re:ut.,t of
<br /> K4r:e owner Or lir. ,�•C a. .'r - 'u�' r.,r..ir,r `n'....,w., rhdr ,n 'hr. ,7nr!'0 r•':4tnCP ,7f the woO for hfr� th tS
<br /> Vernit is 155U4d. •'fl i'r:o' h., ,i•:y .^n ,n ,u• ,•,+. !.., +irt.an� r.gr,pPr-tiat inn laws of
<br /> l i nrnl.i "
<br /> ` Con t rattor'S h+rir.: ,r' r, t - ,., r•. - . r '
<br /> f S - rn C♦ .�.t' ' '.[1,..j' , .. r rr,r,. A. rR -nn pn,.••,n antra of thn wnr5 or wn�rh
<br /> this PPr*,it 15 1tiSJ• ,i- ..r •.e, v. It n' •1 '7rn, .
<br /> l St;7np:i '_ct�._l1.-•f i�r r:�%r.C.y(.. ;--- ✓c ,---_- a na " ._- .=. ?_.+� •.
<br /> 1pCli(a:to' --X51......
<br /> fi vi, �� 1 �, '•t 1.
<br /> r;t t•• ii ,�i//• + .•rsr,,f �i%1.)lliri
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