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~ <br /> FOR OFFICE USE: ��� ���U?���K�� ���@�� <br /> APPLICATIONPermit No. <br /> NC�nm��+e|nT��Qca*e ' <br /> � " ��� <br /> ` \ - Date Issued ..� ��� � �m�r�rm� �mo��wwe� <br /> �� 6 install +h� work herein <br /> \ mo6otu the Joaquin Local Health Di�h'� �v o it to construct and n <br /> � «Pp//cor/cm /� non' U vv�h County Ordinance 549 and existing Rules and Regulations:6e�x|6e6� Thioopp|icoo�n ' compliance " � <br /> | � <br /> ' - -CENSUS TRACT '_---.-.-- <br /> ]O� ADDRt��/�uc*||um -��n����z--',~xv�"" °�^^^'^'"~~ --' ' ---,—'--�� <br /> � Phone �^��'-�����. <br /> -------- <br /> Owner's Nome - �����--'^�� -'``-------'------' -°~^^-' —� '—' <br /> ~7 city ��,/'��x�^�.a /�r�� ._-------'' <br /> Ad6n,o -------- e, ^ '' <br /> [ontrocto,'uNome -- - License v� /��^����-.1- Phone <br /> *���-'°�^r��.�� <br /> � |nmoUotionviU serve: Residence XApartment House�M Commercial :E]TnaUarCourt <br /> ' Mote| FjOther -------------------------------------------- / <br /> \ �'�� <br /> � <br /> Number of living unim`'� -� - Number of bedrooms ��-..Go6`oge Grinder ..�=°.' �� 8ba .��,���.."~`�`-_-----. <br /> t Private El <br /> Water Supply: Public System and name <br /> ^--.---------_--'----__--._----------------------------------- <br /> � ����� �i| � � �c� �3 �� ��1� Silt F-1 Clay E] ��� Sandy Loam F1 [|my�m E3° ' ~f <br /> � - <br /> -Hardpan F� A6obeF� RU Material ------------ If yes, type --------. <br /> , -t <br /> > (plotplah' showing v�eof lot, location of system in ,e|oMun to wells, buildings, etc. must be o|uceJ on reverse side.) <br /> NEWNo septic tonk+or seepage pit permitted if public sewer is available within 200 feet, <br /> , <br /> -INSTALLATION: / � ~' Depth <br /> PACKAGE TREATMENT SEPTIC TANK � �----_--' Liquid -------�ze^ .� w-� <br /> \ Co °^ ' e ''��'-'---' <br /> / ' ' � - 14� Lin'e' <br /> p. -LEACHING LINE <br /> � No, of U j� Leng� of m�6 km*) ��7 ^ T�o| �m�� '�����-__- <br /> u u Type n/`e' Material v"f`-40A�°~, D^r^ Filter- Material Distance to nearest: ' <br /> Well ,J-42- Foundation -/f� Property Line. ~^- <br /> | ,�anitation Permit# ------- ----------------- <br /> M '. __ —..- <br /> / <br /> Septic Tank (Soidfv Requirements)) ----------- --------------------------------------------------------------- �~ <br /> Disposal <br /> Field (Specify Requ|rnmenfs) ----'----'--''-C--------------—~-'-----'---------'---------- ' <br /> } ` .---------'—'-------'^'-----'- <br /> -����^—`'----.^._�--'--..'^--__------.—'' <br /> ~. ^ <br /> ----------------- <br /> ' ' -~- '-r� '� ' �����'—^�-.—'--__. <br /> —^----.------'----__--~~ <br /> ---------------------------------------- <br /> (Draw <br /> '_—'--_'--__(D,mv6xisting md required additionon reverse side) <br /> Son Joaquin <br /> | hereby cmrH'� '~^' have prepared this -''x;cmtiwn and that the work will be done in m*momdmn*e with <br /> County Ordinarces, State Laws, and Rules <br /> and <br /> R*gphxHonm of the San Joaquin Local Health District. Home owner or licen- <br /> sed q�mnvm s��nuyuremwrH�esthe fm||mvv|ng, '� ' - _� <br /> ' i � ,f f �6 � «mr ��[�&�6|o permit �www�� I o6aY| not employ any ��u*�n 1� such manner <br /> ^^| certify that n the performance mvv�, _ ' <br /> as tm6ec & an`* Compensation l��� w� California."��' [>w/no, ' - <br /> 8ignn6 ����c�.-./���`����*`-- -----------------' <br /> iBy -------- - ----------------------------------- Title -------- <br /> other than owner) <br /> FORDEPARTMENT USE ONLY DA�E ..������..�����------ <br /> ` <br /> APPLICATION ACCEPTED -' -__------ DATE -----' <br /> 8UI00N8 PERMIT ISSUED ------------------------------------------------------------------ -------- <br /> ADDITK]NAL COMMENTS ----- ---------------------------------------------------------------------------- --------------------------'--_���- `�__� _ <br /> -.--_—.—^.----� -------�-'----'__---_-----'^----.—._.-------.- <br /> . -----�--_---'------'`--.----_-._-----'---'- <br /> � -------------'--_-�--- —'_-'_---_--.,.--'------' <br /> -^'—'-------�-'' -Oo�e ��m�m�wm���.�°/..����.~,�.. <br /> Final Inspection 6y --------- <br /> -------------------------- <br /> SAN <br /> -.,, --.---_.`--S\N ]OAQU\N LOCAL HEALTH DISTRICT _ <br /> , <br />