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<br /> tr:•rmlt 9,xPirar► 1 Y^nr i rom Cato loved
<br /> •rn�it rC ftY.;rr.v'1 anti ,:,51•:711 ",ii•' v:C � 'rCin
<br /> r1 r�lii'f11,pn ,G i,r•r r�,r .r rirf c. t-, II„ ti v, )�. _! !�n IUC�U IiPUIt 1 i_l }tr i.'1 ticr U I`'
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<br /> .•ir•;r r;r'.(+(.I sir ; cr 1.p',.a nn �. ,u.ln in , ,-•r,l�.;n,r' •wiPIt Cow 'i Orr.-linun,t• t!:• i nnrt
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<br /> _7� / `7 r'�1+ ik I�.FN COO 1 111 rf is
<br /> AddrFt.•, h
<br /> �1 v L 1\I , Li,,anse Phone
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<br /> In,tnllotion will servo: Pr gAnnrt' port ment I louse ! Co�,rnerciri :';Truii4r Court I tt�
<br /> Otlic r t
<br /> _ Size
<br /> Pfumi,;r of bocirooms Gnibage Lrinduy Lor j
<br /> 1`•,'atrr Sul'p:y: Public S',01-- unci narric,
<br /> _ Clp J l-i Peat i-> r Srndy Locm
<br /> r'nrru�rr of soil to ccnJ!h �f � eer '(mc ` SAdcba =+il Scf
<br /> r low, (-j Clay ioanr t:I
<br /> If tran,type 1
<br /> (Piot plan, •;Vo'lj,nq %i/,, ni 101, loCctiii>rl of sy',*.vm in relnt,On to wc-lis, 1rU6lcl11)Ci3, etc, nlUSt lc? pji,iccd on re veiS
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<br /> t it'/0 SP'Jitf. t,tfl%" or if�:;pa;]er pit f')atmitmd ii public; $ewer is ovailoblo within :{til f@r.,l,)
<br /> NEW IN,TALLrAT10W `i
<br /> ' ;ic klid 00PId'
<br /> CA.rKAGC iREI`.7PACP`IT j 1 SEF1'IC TANK ( 5ixo { t'
<br /> Material f No. Compart nlenn
<br /> Capacity Type t.
<br /> Diietrlorp to noorest. Well
<br /> Fuundattc n Prop. Lintz
<br /> LCACI-ONIG UM-: ( } No of I trier, Longth of each lino Total Ldngti, 11
<br /> U 20 r TypoFiltor Motr•ric'•i Dopth Fit�r h5atc ripl
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<br /> l),stnnCM to nealost, tivoil Foundation ( r'rnptrty lino
<br /> SE�f'AC+e f'iT j f DpP01 }Dicunoter Numbo Rock Filled YWs (_! No `,
<br /> f1 —
<br /> Miter Tcr{,ir. fJrpih i flock Size
<br /> fl ..i'oundatij�I Prop, Line .. .
<br /> D.31QnCPt to nPof"01.��r' ?'
<br /> REPAIR/ADDITION(Prow, Sanitation ro,"llit r34�� Dow � l
<br /> Septic Toni, (Specify Rer)uit—Minis) _
<br /> r ►fit,i.� r^• �f A. '. y-• q-�) )
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<br /> Disporml Fiold ,,APV cif•r
<br /> f' 60 � JC.•�=A C 0-1 �•!�C.. -r--�j �L,• � ! �.I�/'v/J ��+''"i"_._ Jam.)�L�.a�i%r'ti!
<br /> (Draw exiating and raqu,rod uclelition an raversrr sic(c)
<br /> I hereby esrrtify That 1 have prepared
<br /> opp!icaiion lune: that thv work wid Le 4060 in occordance with Son 3esu0,u:°``
<br /> County Ordinance%, State Laws, end ilvfvs and Regulations of tho '41A 1oo,4uln Local Weolih C11,410, }Immo owner i r lizois•
<br /> scd a�anI Ih-JI lure cartifles the foilrawinot
<br /> "I certify t a11in lho fit) ,rm a of tho work for which this pgrn,ir Ir iesucJ, i shall not vrn}iloy un'y rweal':an in tueh sJasznea
<br /> as to bice subjo�t is Wsr'n, n t �tmponsolion laws of Colirornics,"
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<br /> Ownrtr
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<br /> By
<br /> ill �,tl„'r tl,un n,vr'rrJ
<br /> FOR fDEPAIUMENT USR ONLY
<br /> f` ( , DATE _..-
<br /> n;ri ICnf i:)rI l+fcCi'1 Llr fl e r ' DATE
<br /> ,7 Jil i)i�Jt: i'ri'"AIT 1;5t.1C ..
<br /> MSUIC.T
<br /> ''�,f: .10 ,i i:l'Al. itEA;T>f
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