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.. o <br /> FC dt tie APRLiCATM lM SAIWTAYM MWMI <br /> 2 t M Tdpilealrt Permlt No .. <br /> .........1, ....... 7 <br /> ......................................................... "h Pa"lxpkw j vow hem be*blow <br /> Ap�ticatlon Is hereby mode to the San Joaquin local Health District for a permit to canshvd and prutali the Work hewM <br /> describa+d. This application is amWo in Mance with County Ordinance No. 5#9 mind existbq W",and Regulatiana <br /> O8 ADORESSJLOCAT CIS 1RJ►CT . <br /> Owner's Name -!•-.. : :. ...... ... ..Phone .. ................... <br /> Address Cly...Q`-c-r?4 . . .. .. ..... <br /> .:. ....Lie"# Z <br /> ..... Phase ...........................Contractor's Name .... ... <br /> Installation will s rw� Residence ff Apawhmffl HOMO COm mood al Ostler Court <br /> Motel 0 other.... ......... <br /> Numbs <br /> of living uaits,........�... NwtGrrber of teselroesms .....�...t3�cubaige 0rirwfer ............ Lot �- <br /> Wow Supply= Public Splem and name ......................... ....... .. . .: ......... ... ... .... . ......... ....hl%Ov tr Cr <br /> Character of soil to a depth of 3 feet: Sand L3 Silt[} Clay D Peat Q Sandy Lean Q OW Leapt Lit'- <br /> Hardpon C) Adobe 0 pill Mcdwk t. .........If yes,.............. ............ <br /> (plot plan, showing size of'lot, location of systern in asiallon to wells, buildings, etc. Must be placed of wAm "j <br /> "m WffALLATXM (No septic tante or seepage pit permitted ifsewer is avall t*40&200 feet,( <br /> PACICAGE MATMENT j 3 SEPTIC TAW Sin..`:< l..t!./0.�-r..� ` Lkp Deplh ....eiA...�............. <br /> CapadtV ..la I '? . Ty{ae 141aper . .Aw .... No. Gonnperttnads ................. <br /> Distaoce.to nearest: Well ........S�..t�......,...... '......Prop. line . k-1...... <br /> lEAC3ffNG LINE f No. of Line: .......5.. Length of eachtine. . ... ... Toted to ...1.;:A :..... <br /> 'G' #lox .t.... . Type Fliter Material . ..5:. + Filter Material ......J.-I......... <br /> Distance to nearest, Well .... a Foundation -..1.�!..�.# ...... Properly Linn ..:�-alt-r........ <br /> SEEPAGE.P.I�T. j aeph .....,�--� G <br /> cm+ r ...........:.. Nb. .........4 ......< tOdTitled Ya tb <br /> Water Table .......................... ......Rock Siee ... .. .? ... '::. <br /> ... • <br /> Distance to nearest: well . ...:. ..I. .... ..Foundation .......Ln..k tine....�.��..:.. <br /> A//ADOMON(Prov. Sanitation Pomit#_....... .....--••.......... Gate <br /> Septic Tank fSpocify Requireanents) .. . .. . . .t �.. . .. ......................... .... .. .................. <br /> ' Disposal Field (Spedfy Recluiremertsi <br /> .. ... .... ... ............... .. .... (Draw..........................I. ... ........ :......................... <br /> existing and required addition an revem side <br /> I ""fy fleet 1 #raw RaPQM4 tMs t asrul the weak<wN be done in -1- s <br /> ..whir <jamp <br /> County OrdRrromes, Smm laws, a" UW OW Rego tees of the Sear a toad HreSlls"of W "me *%*W er <br /> sed."""sigaartwe a,ertwn flat mood".. <br /> "I certify fist In tint perfemaree of 60 week for*+A*gads pemw is lsssred, l sw uet srRstW my men In W&memw <br /> as to become subled ft IN 's a taws of COW&"" <br /> signed <br /> By -- •...... ......... : ...... ............... ._.. . . ... . ...... Owner <br /> ...................................... r ...±.. <br /> ............. -....... ... . Title ........................................... <br /> (If other than owner) <br /> sm 216rART um MY <br /> APPLICATION ACCEPTED BY....... :. .... .. : _ - -------- ....... ...... . . ... .:..:. <br /> BUILDING PERMIT ISSUED'... ......... ......... .. ....... :.. ....::::. ::::--.DATE <br /> ADDITIONAL COMMENTS............................................... ....._... .... .. ... <br /> i=irrat tnspection Y •b • -•---- ................ ....................I..................... <br /> Mi 13 24 1-68 Rev. 94 <br /> sArl J+C>AQUIN LOCAL HEALTH. DISTRICT 8/71; 3M <br />