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SD DIVISION OF ENVIRONMENTAL HEALTH SERVICES?
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OWNERS NAME —Fri ,ILK Q*--t!dg- -612S2d" PHONE # i'mil Z- i #.1
MAILING ADDRESS I If U-t"" el- em V,4 ccgj tizy -, to 5-172 -
APPLICANT Ajt4
NWM A RSMUUMft #A,, OWW, WWI, COMMOO
TYPE PCHD COMPLAINT#_
ATE F IM ..P65
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INSTA W �-AP-D -2,
ROPOSEb UZR PHONE #
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ADDRESS i-�4-w-Q #4-L::tZ Ki- J6 r�7 T REGISTRATION /UCENSE 0
Onckgle, a squab defth bcs" #0 hOU84o WOPWtY Un8% ell s*wmt wells wUM.n 200
fgd of repdr mW the WOm of vftU" and pmposed system)
NOTE: The b"aftent may mqWm mibmft of puposol ftm• gmmd Indmolonol dependbW on the
nature and adopt of the repok.-
SIGNAL. IGNAL. TITLE Cc.-We,^ DATE— 5--lalo's-
1,..tire 8601c IpSW, ARNIP tO P010131Y wkh the Conoftn.e Of this pem* for the sapW symm
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TITLE
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1. Aca"mom of any Tom Pwn*. it SWAOMA&
2, 8UbmWm0fv4 built mPWslmWl byft septic symmn kWt"ffv4M 90 "s of" repe&. lndWUcmmv*lW-
Owner's name, She eved Nmmi Tmn and Tax MW mmtw
b. LmadW of kmWed ownpmefts tied to 60 fond puba
c. Sysom desmipdW (mg-, 1260 gal. Cmamb 8Wft ork Mr.)
cL lnskMW name surd phone im! - dxv
3. System mp* W be pwbmW In accordance wM the at6ve propow ow cbriftwo
.4. The' proposed SM repair. Is cOnddared a Ud ft design and there Ig re gmanteg jo #0.& ration at whM the
wmpkad 8STS mp& wN tmdm
S. No cxn*W work Is W be bad" untl =Wwftmdm to do so hm been W8hW irom the NWmmt
PropomWAMmo
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COPIES: PCHD; Owner, lnsbdW
PC-RP 99ML
Proposal Denied
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MEMORY TRANSMISSION REPORT
TEL NUMBER
NAME
FILE NUMBER
DATE
TO
DOCUMENT PAGES
START TIME
END T I f,f
SENT PAGES
STATUS
FILE NUMBER
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119
MAY -28 01:15PM
95262595
001
MAY -28 01:15PM
MAY -28 01:17PM
001
OK
FMAY =28 -2008- 01:-1TPM
8452787921
ENVIRONMENTAL HEALTH
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