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r FOR OFFICE USE- ^U�w���� -- - <br /> [ ~ <br /> . _ <br /> ............................ - _- ' FOR SANITATION. vEmMoo � <br /> 0 . <br /> Nm Permit No. _�r��. <br /> . / Doti Issued «�~ � <br /> . ` <br /> Size_Application is hereby made to the Son Joaquin Local Health District for a permit to con <br /> described, This application is made in compliance with County Ordinance No' . strL;d and Install the work herein <br /> 549 and existing Rules and Regulations: <br /> Wlcw <br /> JOB AD61RESS/LOCATION <br /> Address <br /> City <br /> Installation will serve: 4ftsiden'ce 0,A" <br /> Number of living units:...I------- Number of bed <br /> Water Supply. Public System and name .............. <br /> Character of 3011 to a depth of 3 feet <br /> Sand W Silt El Clay 0 Peat Ej Sandy Loom 0 Clay Loom 0 <br /> (Plot Plon! showing size of lot, location of system In relation to, wells, buildings, etc. must be placed on reverse side.) <br /> INS <br /> NEW TALLATION: INo septic tank or seep pitpermitted If <br /> � PACKAGE TREATMENT ,�^/' - -._. _-- ._~° . <br /> f ] SE*T��TANK <br /> Capacity Type Material <br /> istance.to nearest. Well �o <br /> no <br /> um <br /> Distance to nearest:-Well '� , '61, <br /> Septic Td6k <br />( -----._-- -----------------. <br /> .......... ----------' ----------__-----_-.__--'�''_-.--_ <br />. --------. --_.--' +-____ -~-_ � __- � / - , -------_---_---'- <br />. -_._----_.-, `_--_--'. . -_-'-'-- ^ ` <br /> �ravwmn�8mg and required xmddN4mnon <br /> ------`----~--------''-----'`'-�---- ' <br /> U hereby - '-'~-~ ~~~~' <br /> ill <br /> =w�erflfy.that I have Prepared this application and that the work~_~~. ~ ~ ~ |andAegulation <br /> ' <br /> ~=d agen�signature wm���mthe'-'-~ ~: -C11 Health, _District^ Home owner or "com. <br /> "A certify that in the performance wfthe . .� <br /> -~` ' �`�'~ @w�w ��� ��� � ��n &m ���w�, U *�«^� not ��� �mnw�� �m m��� manneras to become mub�ct 'n laws of California.,, <br /> ' <br /> | <br />.---SigniM _,�� <br /> ^ - -Owner <br /> By `°� \ ��'� � }~ \ T� � <br /> it <br /> Ufother than qmne� -----'--''^''-'-- *"= -'�'--^+----------------'' � <br /> - ! <br /> APPLICATION ACCEPTED BY <br />' _____ ------~---'------_______FOR DEPARTMENT USE ONLY <br /> -_'__ ��'`-----'' 1 <br /> Final Inspection --------'y'�/�� -'----'---'------'---- _- _- ' <br />' <br /> Elf 13 �� ' � �m��° --'7�-'~'^ ---'-�-'---------,-.��m�. .�-������.-�//�/_____ <br /> - - ' �~ N. J��/*�UUN LOCAL | 0�TRM�- ~ ' <br /> 8r /4 3m . <br />