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G <br /> PERMIT 1 <br />B AN JUAN ~A~IN HEALTH UNIT <br /> DUIIAN0D. CDLDIIADD <br />• <br />9803 No. Main Ave. .. •..ex i.o ,s~.~~o,.. ..•-.+o• <br /> <br /> ..,..,., <br />APlLICAlION A1D PERMIT !0 Ir!!•LL. COrll0'CT. ALTER OA RIQAIR I~DItRDOAL BEIGGE 878TEM <br />FERMI! E2PIRE8 120 DAYY I OM IY~M CE <br /> <br />Oif17ER OR 6PONSOR: Lrt n 1 <br />/"~!(/~ <br />~ ~[~~ ~ I , <br />~ r).''- ~l •~!` ' ~ <br />• <br />MAILING ADDRESS: <br />ADDRESS OP BITE: <br />GOMaaL IiPORNAlI01t <br />1. Living unite / ~ ~//'r f/"r~/~'r <br />2. Number of bedrooms ~ i. _ <br />3. Number of bathrooms _1- 2 o f/.~, N <br />4. Automatic diahwaehar__ / / <br />5. Autotatic lnundry /~IQ/k~,~i <br />6. Gasbags disposal --- <br />7. Hater softner <br />8. Lot size <br />9. Hater supply r' ' ~H /(/~+~~ <br />10. Percolation rate <br />11. 8ol~p~~ile /r~,i~• S~ ;,~~ <br />12. Bedrock depth it -~~ ~' <br />13. Hater table depth ~,~ ^/,. <br /> <br />• <br />r <br />AcRS~:t ~ <br />The plane snd <br />;.~,, <br />~: <br />~rJ <br />/~ <br />Y <br />r/'/'~ t 1 /y' <br />LLL <br />BEYSIC lAQt <br />Liquid capacity ~ 1 ~ ~ Hat. . " <br />E'iT®~ID /~t11I01 e ~ s' <br />1. plc ti y ~~ <br />2. P al treatment: <br />a. ubaurfacs discharge <br />b./ a rface discharge <br />BDE{~I1C1 DISP08ALt <br />Bed Lines Length__ <br />Nidth Depth Cover <br />/ <br />Bo tom size <br />830 • Lining <br />{^~ / ~ <br />~, , <br />,, , fl s /fir l~ l?k' /~'tj <br />Thi• system will be constructed in accordance with <br />tions governing~ii~n7dividual •awag• diapo al sya s <br />DATEt 2 "~% -[I / APPLICAYlt <br />INSTALLED BY: <br />PERMIT PEE: S <br />the ^bove •pecificationa and requle- <br />of the San Juan Basin Bealth Dept. <br />are approv pending payers f P •. ~~? <br />i <br />ARITAAIAN - <br />By ~l ~ZJ DATEt <br />A [IW. IsSPECTIW I8 REQBIAID f ~ / ~K l-rs~ ~d'Zr <br />Location of tank / <br />The above system has been inspected and found to comply with the plan and description. <br />6ANITARIANt <br />DATB: <br />r -/ <br />