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<br />JOB ADDR.CcC 1...149 I • "I•i •
<br />Owner s Nramn )sO)ia PI
<br />Address -_'t--. fi
<br />.rrLIC.,ATION FOR SANIT t,110to PER
<br />(Complete in Dimlic.,e;
<br />This Permit Expires 1 Y. .7 . Date Issued
<br />4 ; ; - I ....-I ' .alils Dis!.. • --- ec•r,t+,,ct
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<br />717 t . 1'r- 4.)
<br />67 r 1 , VkP ri 1'12.
<br />lie)_e "AY ' ri„: ••.„. 5/
<br />Contractor, s th•l•rh t )1. L-44.1;
<br />Installation will serve on r., . ,-,nh , f loASe 0 COmme•r * 1•eiler, CourLE1 , Moth 0 Qt)!er DI
<br />(-.5ra 6 e"— Number c; 1],v n, in '. c•-• ,; berfreoms . Nu-nbrq cl :•••-.. . i of size
<br />do r,• P5P ' X .---' `-0 .1 Water Supply: Public ••.'.• • .tN rvstem 0 PrivateX t'••: • •D Wet', Intl.. P. L' r•
<br />Character of soil to a depth el "1 fr—t .,•• i ( ) C.—ravel 0 Sandy Len— j Clay Loam 0 e.' rav Li A.do1--elit Hardpen
<br />Previous Application M-!ø: I' • 1 No 0 New C.--.4ruction: Yes' g No Li rivA VA "res D No 0 '%"•••.1/4 •
<br />"WE OF INSTALLATION Arm
<br />(No septic tank or cnrsevic•
<br />Length of each 1••••• '9707 Width of f.nnch
<br />t ur-; ..•
<br />D;stnn,..P ...••••••• ..v011
<br />Sq r • • • es , ,••
<br />tl'' • •
<br />Distance from fc...,—..I.rat•nn Lining material
<br />Depth.. . Liquid Capracit) gals.
<br />Dktrance from nearest building
<br />
<br />R•ItICvdel;na Andio. • nr ••,,
<br />SeSiT6hir:
<br />Disi,•.•4011 F.c'd:
<br />)1(1
<br />Sege
<br />Cesspool:
<br />0
<br />Cr;vy:
<br />s . ••
<br />tin. • I
<br />Pk :
<br />Num''"•'
<br />S"ErItICATIONS:
<br />' rtrmitteci if pulic sewer h available witl,in 200 feet.) /
<br />. „..1 fi-D k) /
<br />5 )1 1Lqud deptli //- / Capacity...70.6.f.
<br />Distance from ic,;7;6eitic,h /0 f • Distance to nearest lot l'n
<br />i yep r-Xf Depth of filter iq rl . 1011,1
<br />I
<br />/ If :Distance f •rn fp-rfetion I v
<br />J A
<br />Lin;nq material5eit r (:lzr: Die net r.
<br />QL);ancp,to nearest 134 line..
<br />" Depth 5-
<br />. . . ....... ri....-.4....... •.c. It. ,k . . -.4 ... •••7 ••
<br />
<br />I hereby certify 0,4.4 I h•vr. .......r1 ski,o d 'het the work will b. dell. 144 accordan with Seri applicall. ni4: ."'
<br />ordinances. Slate laws(71ri. ler 4net;reoidetions of the San Josquin Local Health"Disfilet. . , ..
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<br />: (Signed) .....;.1. /
<br />By: r I 1 '4: ...„::..., . I.J;.. i" H.) ili ;".1 .: 5*5
<br />(Plot plan. showing size of lot, location of system in relation to wells, buildings, etc. 14 pleced ton 4verl.
<br />4
<br />;i
<br />atilt County
<br />Pontractor)
<br />FOR DEPARTMENT USE o
<br />-
<br />APPLICATION AC( F-Firn
<br />REVIEWED RY
<br />BUILDING, PERMIT MUM
<br />APterations and/or recommcn irasivnt•
<br />/1 „
<br />;21473—
<br />,
<br />' OATS
<br />',DATE
<br />DATE
<br />art%,,/:...it'' • ( e •• , '•
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<br />.4t.t ( , • . •
<br />r • ......
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<br />FIN At It :;•1'14 - II9t4
<br />130 Souel,
<br />trilli••
<br />,es Vi•ot 1111, St.est
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