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4356782224 International uranium 11:04:37 a.m. 02-07-2008 8110 t: <br />02/07/2008 11:07 N0.892 D08 <br />FROM S SAN- MIt9E? COUNTY 970 72B 6325 PMON? NO. 970 728 6325 Jul. 30 1997 0V 5" P <br />A S.4N MIGUEL coUNW BUILDING DIPARTMZNT <br />PZRWr APPLICATION CHLC ,LU <br />K <br />ENMONMENTA.L HEALTH <br />Yes/No <br />I) p? Does this project include any NEW solid-fad burning devicos, gas log <br />fireplaces, or gas fireplace appliaces? If yes, please supply make and <br />model #. <br />C 1 ! Does this project involve any CRANGZ to an existing stolid lud <br />burning device$ in tog fireplace, or gee fireplace appliance? <br />?(' C) Will this project Involve inetollation of a new indhidaai sewge <br />disposal system, or modification of an existing sewage disposal system. <br />I I X If conga mad to an existing individual sewage disposal system, will <br />this project involve any additions otbedrooms or increase water twee? <br />l <br />I) I Does this project include plan s for a darkroom or other activities <br />luvolviag use of chemicals? <br />I I IX Whitt is the proposed water supply source? private well <br />,? <br />munidpal ?l other w A 4-e m 14%h l c b <br />-1e -thy 5 ? t4r" <br />I IX Does this project include plans for any water treatment equipment? <br />C I LkT Does this project Inelude any Ie WAnina pool, hot tab, or spa either <br />open to the general public or part of a public ACCOmtuodedon, witb ` <br />ratals ofless than two weeka? <br />f a Ql Is this a restaurant, catering busluess, retail food market, or any <br />eommoreial food servioe planned far this project? <br />If the project includes an existing restaurant or retail food market, <br />are any elwuges being marls to the commercial food service <br />establishment? <br />t?A3+ or N 'A Milk (4% 4)1 0-11"" <br />APPLICANT <br />NAW4ruv1r FAX mMo 01614 M I1 <br />it '. <br />Uwe, Irv- <br />calm. ?, <br />"'i xa>i? I <br />d,Y / I