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PERMIT # <br />~ y~ ~ <br />-- SAN JUAN BA51N HEALTH UNIT <br />DORANGD. COLD RAOD C / <br />3603 NO. Maln AVe. .. v. •oa .•o CX~7~ (T ~ +c~c •.. a..c a. +~s+ox <br />B13 D1 a•+•s+oa <br />a•+~s+o. <br />APPLICATION AND PERMIT TO INSTALL CONSTROCT ALTER. OR REPAIR ZNDIVIDO T. EWAGE SYS w <br />PERMIT EXPIRES 120 DAYS PROM ISSDANCE <br />OWNER OR SPONSOR: <br />MAILING ADDRESS: <br />ADDRESS OF SITE: <br />PARCEL NUMBER: <br />GENERAL INFORMATION: SEPTIC TANK~aK <br />/~ ,~ i <br />1. Living units j n~a eyjs~ pq~q~~ iquid capacity /L~'l'7(~(: Mat. 07 rP~ <br />2. Number of be rooms ~ <br />BRTENDED AERATION: <br />3: t7umber of bathrooms <br />4. Automatic laundry y~c 1~. .3.p ity _ <br />5. Garbage dis osal _~L ~ $_ 2. Final tr <br />6. Lot size ~3~~-~.~f~'-~~ subsurface rge <br />7. Water supply ~~+ b. surface discharge <br />~, ~~'~ ' SDBSDRFACE DISPOSAL: <br />8. Percolation rate ~~ ,q , <br />9. Soil profile Bed ~? Lines ~ Length,~~ /~ <br />,Q~ 11 n~~„7~ Width /d, Depth~Cover 'r 't' <br />10. Bedrock depth ~~~ ~Oii <br />11. Water table depth ~8+~ GOON: <br />Bottom ~,,,. <br />COMMENTS: 510 __ <br />~ Gls~ S~~f ed~~ yo'' f~ ro~ti down s-freen.i sict~~ o-~Seca~,d <br />a,-~.C . <br />~ h9a,~...,~~~ 3~n.:.T de~fS ~~rok~~ G~i/ve i''a~,~o4vL>~i~ aHc~ <br />rao a' easen,~: j <br />37 /~ ~ta.•~.~ ~o'~e~ run o„ 2i-~~~ side, ~ P cz~a 6i~ w~rv /ite, <br />ero~s~ ~ mac,-~-~h ////5~~. /80 uv/ sue/ ~ ~e~ eosin e~_/c%s/~~~_ S~ `/O. <br />~0~7ei r'a~ .Sc~i 7~ f/ir04y~i f7+~~/Ct~~ly~ OVt°i!/ GTi~G~ /~ <br />/Llahttdr-n ~O ~ .oe~QU~G .,~o.~+ lea c!1 Tie~i~ fo rtoi.a Jry-i~a.~or~, . ~clrt.. <br />AGREE!ffitIT: ~~ir,... c.~j_ ~^// S iG~?~~~ ~op~,~/,P~kyQ' ~'o d/v~ /rr~~o-~~~~p,~, <br />This system 1 ~~~S~ruc ed in a oidanc~ witti~he above specifications and requla- ~~ <br />tionsgo/verning individual sewage dispo~s/al systems of the S n Juan Basi~n~~Heal~thyDept(J~.~j 1J <br />DATE: ~~, ;~~,~~_ APPLICANT: V ` ~/~'~flxU ~D./Z(~0~""`~~/~"~/! ~ /d'~ ~J <br />The pla s a d specifications as shown are approved, pending payments of fe . <br />~n <br />INSTALLED BY: SANITARIAN ~ •~ <br />PERMIT FEE: 5 ~ ~ RECEIVED BY GJ ~ rZ DATE: IT ~J <br />A PINAL INSPECTION IS REOOIRED ~~ ~~ ~ / / ~~~ <br />Location of tank/control panel <br />The above system has been inspected and found to comply with the plan and description. <br />SANITARIAN: DATE: <br />