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�-� <br /> ` <br /> 'O° +"'^-^ USE: <br /> APPLUCATION �OR �N0����N PERMIT _� / <br /> APPLICATION ..FOR �� � , <br /> Permit No --��-_- <br /> N�m,np��eyn ��p|�cm�e <br /> \\r~ �' � / ' 7� <br /> �xw- ~ Dote Issued �� -�d'!.-~ <br /> From �m�wU �� --'— ' <br />---- -- - . Thi ~ <br /> Application'— - he hereby to the Son Joaquin Local Heu|H, District for o permit to construct and install the work herein <br /> compliancedescribed. This application is made in hh 99unty Ordinance No. 549 and existing Rules and Regulations.. ~ <br /> I 101V <br /> T,9 ----!-f —----------- -Phone <br /> ,57 <br /> Pho <br /> Installation will serve- ResidenceXApartment House,E] Commercial'E]Trailer Court <br /> � Motel [-1 OHhnr..��'�'n---------------------------------- <br /> Number of living unity---/---- Number of bedroom s.���_^ ,6ogn Grinder Lot Size -----------.-'-'- <br /> VVota, 3upply. Public System and name ----- ----------- --- . ----------------------------- ---'---Private F] <br /> Character of soil toodepth of3feet.- Sa~ !E] Silt `4ftay E] peat E] Sandy Loom E] Clay Loam [:1 <br /> '. plan,'.showing size of lot, locationi of system <br /> � v <br /> NEW INSTALLATION o septic tank or seepage p� permitted if public sewer is available m'�hin 200 feet) <br /> PACKAGE TREATMENT SEPTIC TANKf ] Size----_--------- --------- Liquid Depth ---.-----_. <br /> Capacity Type ------- Nky��o|------..-- No, Compartments -_----'-' 8~� <br /> -_ -- '- ` ` <br /> ' 0mmncn to nearest. Well -----'- ---------- .FoondoMon ----------------------- Prop. Line ---.--'_--' <br /> LEACH|NG LINE [.} _No. of Lines --------- of each line----------------------------- Total Length .—__.__'_ <br /> ----------�� �� �D -..~ Filter Material -----.-.DeoHh Filter Material ---.-----.---,'--- � <br /> ! PropertyLine -.-------' <br /> SEEPAGE PIT <br /> Dept6 --°'—^---- D.~.__ ---------- Number-._ ��_—' Rock Filled Yen No <br /> ' VVote, To6|o Depth -�------'--_'_--.-Jlock3be _--__--_ <br /> u�~--/ Distance to nearest: Well ----------------------------------------Foundation ------.. Prop. Line ...................... <br /> (Prev Sanitation Pernnit# -------------------------------------------- Date ----------------------------------1 <br /> Septic Tank (Specify Requirements) ------ __—._----' <br /> u/xpnmz/ Field (Specify Requirements) '----^~~~-~`~~'----'~^��- ------ <br /> - —'------------' <br /> m� ^� � * �� _� '� / <br /> --'.-----_._�-_'---'—.-��--"��,x—..`_.,~~^c._� .-����_--__-_'--_--' <br /> --------- --------------------------------------------------------- -------------------------------------------------------------------------------- <br /> existing and required addition on pmvmmo side) <br /> | Hereby certify that ] have prepared this application and that the work will be done in m««ondamme with San Joaquin <br /> County Ordinances, 8^m*e Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner mrlicen- <br /> sed aaen,sp|gnaturemart|fiom +6efmUmxving; <br /> ^`I certify that in the performance of the work for which this permit is issued, | shall not employ any person }n such nnmnmmv <br /> as to be*w,nw subject to Wm/kn,an`m CwmpenumV[wm laws of California." ' <br /> Signed Owner <br /> (if othe owner) <br /> FOR DEPARTMENT USE ONLY <br /> -------------- <br /> DCOMMENTS ------------------------------------------- ------------------------------------------------------------------------------------------------___---_ <br /> '� �X�' ---'--'--------'--'-----'----- <br /> +`f^^ `-~ ____--_______.____-____________ <br /> --�-------� ---- ' -- - <br /> � Do/elRno| |nspechonby - --__- '-'NW��+' <br /> |N <br /> LOCAL HEALTH DISTRICT - <br /> EH. 9 l''68Rev. 5M � <br />