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<br /> FOR OFFICE USE, APPUCATION FOR SANITATION PERMIT Permit No, 7,S_ ., 7
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<br /> CENSUS TEAM1
<br /> JOB ADORESWLOCATNON IO 9K 4 ...I7� ., Ph Oft
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<br /> insldlorkm will sato&. Retidnnm❑A Q Camenetddf p2mller Cawt
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<br /> Number of i;vin® unHs: "`�
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<br /> Wain SY➢PIY+ Public SYswm and nam»._..� `�"1$""'
<br /> China"of sail to a eOpth of 3 fee, Sand[7 e❑ CIOY © 12
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<br /> Nanfpan 0 Adobe 13 FRI A4abHW...........-Ff yes,tYp'e...- ....e......
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<br /> {Pim plan, .hewing sire .f lm, latalian of -Y&IM in nloRon to.11 , badlnflt. els• meat M placed an f*WOM }
<br /> NEW INSTALLATION,- III walk lank W seepage pit patmhwd If public suwec It 04,111011 within 700 feet)
<br /> ",/ SiSei�..I,tK �.+Ft,R Y........ LcgYld Depth ..»....•
<br /> PACKAGE TREATMENT 1 j SEPT�rIC TANK(q s
<br /> Co�acId :2#0¢/jQd,Q Type, "' Maletiol...w.r-n4`'� No. Compow"I ^3 O
<br /> Diml Fo naaA'CA Wall aMll�!"7'- '�tr. Fa mid011an (�' ,.Prop• n /"•T••_._�
<br /> .. Lengdt of dads fins_... .. ... ..... Told tenglh ............._._...,LC
<br /> LEACMIRIG UNE I I No, of Lbws ........... ,- 3aa
<br /> 'D' Box ._ ., Type Filter MWklQl ,._....DRPIh Flute Moeedol ...........
<br /> Distance Ia nwiatfc Well foundation Proporty-um
<br /> Depths .... �pLor�1FGltmirr / y....��}/``16eda tRIMd.tlp E3� Jia'Q
<br /> Water Table Depth ...... .. .....Rock Slee,/u�':IA . .......
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<br /> REPAlR1AODITiON iPrcv.Santlei'rae Permit i♦t ... ... DaM ..,..•
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<br /> ' Septic Tank ISpec9fy Requ;rMo nl ......... .. .-..._..
<br /> R:apOrol Field ISpe<Ify RequnmmdTl •....,.....•.__
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<br /> I henbY certify Choi 1 hate Psaperod IEM application and Ihat Me week wm be chew In oa erdanta trFlk San JoWIRM
<br /> i County O+dlnotcat State loon. Med Ruble and RegvIONeM of”San dOMgala Lead Retain.DlslAd.Nteaa avMse,a Ilcem
<br /> "d.,.I.sig.aluro nnlflac the following!
<br /> "I,Miry thin Jn the Perfaxmenco d Me w vm k far width Ikis P.It It issYad,1 shell net MI any Pane.In•och manner
<br /> as+e bacon.sublet ru WaAmon9 Campaesdle.laws of Callfer.la."
<br /> Signed ... ,., ..._.,.......•Cimino,
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<br /> ltf other then aentsd
<br /> OUR DEPARTMtHT USE_QKV
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<br /> APRIICATlON ACCEPTED RY ,Cr- �".!c-drr � .. ..., DATE `3 �7' ..... . .
<br /> SUROING PERMIT ISSUER _. .., ..,.DATE _.
<br /> ADDITR7NAL COMMENTS
<br /> EH 13 2G 1.613 Nov. pt SAN JOAGUIN LOCAt HEAII DISTRICT 8/7b 3M
<br /> 11/10/2011
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