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' ~ . <br /> LOF7FICEUSE: � � ' <br /> FOR ` APPLICATION FOR �A]�UTATUK��| PERMIT p*nnhNw <br /> Ncwn°p/ t-imYHpli*at� 73 <br /> ------------------- <br /> Date Issued <br /> Thi's Permit Expires 1 Year From Date Issued <br /> --� � construct and im�U the �rk <br /> herein <br /> is non�" o� � �e �nJ�quin ��'iH�� District for o |t to <br /> described. application is made in compliance with County Ordinance mu� ��v and e»/,nny °"'=" and ^~w--ions: <br /> .. <br /> . . <br /> �� ----------.-�--/�ENSUS TRACT ----.^-._- <br /> JO� �D �ESS�LO[AT\om =�..^~°....^.. ---_. �------- <br /> Owner's <br /> - ~~ -.�n�ne ,�'��'^=^-��''' -- <br /> OvvnorsNume --.x������\�.��--.�=.«e��^w.���~~---.---,- _ _ <br /> C3ry`��~� u~m _� ��u��=~-'--------'- <br />/ <br /> Contractor's Name -- ��mn,e�|cJ��Tny/b��oo� <br /> Installation will serve,serve, Residence��A9o�mentHnmya�] <br /> Motel F-1Other ------------ -_--------- <br /> «2 '' � -------------- <br /> Number <br /> --' <br /> Nwa6erof living units: � ' Nvmber of bedrooms ." ~.-' oroc�e8dnde, ^ ° ° Lo+ S|ze <br /> . � <br /> _ <br /> 'Private <br /> Water <br /> K» <br /> Va, , 3opp�. Public System and nonn _.��--_-'_---_-_'-'--- ________.__ <br /> �o -- r� �i| � a6e� �3 ��. ��� �|t 0 clay � F�� ��y �� � Clay-Loam <br /> Hardpan F� A6oboW Fill Material i -.. |fyos,type ---------------------------- <br /> (plot <br /> � �-_-- <br /> (Pk� plan, showing size of lot, location of oyx*am /n n:/nom. to wells, buildings, -- � <br /> _ <br /> O feet) <br /> "E~ ' ~~ (No �*p�cto k or p� permitted � public sever is available within 20 `^ '"~~~~^ '°E ---' [ ] S2PTICTANK:JA Size-----------------------------------,-_- Liquid <br /> -^---__ <br /> Cmpodty ----.- Type -------------------- ---------------------- <br /> _ <br /> ~ <br /> No. Compartments ----------------- <br /> ----------------- <br /> Distance <br /> --'_'.--------Di:tonce to nearest: Well --------------- °_~'__-Foundation ' Prop. Line' k ' - -.- Toto| Length ' ' ' ' ' <br /> -------- <br /> LEACHING LINE No of Lines -------. Length 'of each kn*.=- - ko�edo| -------------------------------------------- <br /> 'D' <br /> '' '-'-'--- <br /> % Box -'--� Type Filter Material F\|�v _ <br /> ~«' <br /> J~ <br /> Foundation Line ------------------ <br /> Distance <br /> --'-''-- �0 <br /> Di�once ,� nmona�. VVul _---_-. ---.---�� ,-,-, � <br /> ' ��ck �|�� yao �� N� �] <br /> ' !EPAGE �T [ � Depth ,-----.. Diameter _----' Number --.--.--'_ <br /> -~-------- Water Table -Depth ------------------------------------------------- Size --'----_- <br /> ~ <br /> -Pr-o-p--.,Line�-n�-----^-_-- <br /> .'-~-_-_~-^. <br /> Dixxnnce to nearest: Well -----------------------------------------Foundation <br /> ' � <br /> (Pnay. �on|��iqn Pern � � -'-.-.----- --- Dp�m '_--'_'] <br /> �~"~ �� ---------------------------- <br /> Septic <br /> ^-------'-'- <br /> Sep�cTonk �pec�yxequirome»�) � ''-'--'-'--'-'----'---- <br /> ^ <br /> , (3 fyRequirements) -----../ --° � =v <br /> Disposal Field - -- ._ <br /> �c - <br /> / ��'-- <br /> ^ --------------- <br /> -------------------- <br /> ---- ^ " <br /> _-_--____.----'-'-' -~�'� <br /> --�'----'-�---------'- ah,h n6 required addition on� (Dnzvv existing . <br /> ' ---� '- � ' ��mY 8` xv�r&'�A|1 be done in accordance with Sow Joaquin <br /> ` l �� �� H� U have prepared t� ��V��� w� � � Local Health ��� �� o�� � �� <br /> | County Ordinances, State Laws, and Rules and Regulations of the Son Jwaq m <br /> ^ <br /> sed agents signature certifies the following: ��rmml | issued, 1 shall not employ any pwavmw in such manner <br /> ' "I certify that in the performance mfthe vvo,k ymrv�h1chvhls � � ,www , <br /> as to becomesubject ^mV�w km ' Compensation 1m�� w� California.�m �wrn��.` <br /> {}vvno <br /> � <br /> Signed cd ---------' ---- <br /> ' Tide -n�����,�x.��r _--____ <br /> ny -----------''�- �-- ''—''��rxr-- - �~ ----- <br /> (If other t novvnen �^ <br /> / FOR E;NT USE ONLY <br /> eDATE <br /> > APPLICATION ACCEPTED BY - .--'`�'/^'m°--)---- --- _____-DAT2 ---�---'---------- <br /> ` <br /> BUILDING PERMIT ISSUED ---.�-----.-----------'-------_______________-^---______ <br /> ADDITIONAL COMMENTS --------'----- .c���'�][�--------------'- <br /> --.---'---------'-------- -)�Y7--- _��-� +_'--,��. <br /> � �`-_.-~�-_--_--���� <br /> | -�--'---'--'' - � �-----'--'--' � � <br /> ` --------- __.---..-Doh* -�r'��°)-x�r--�.--'- <br /> � Gno| Inspection by. -.77------ <br /> SAN <br /> -.m�� �^ ------------ ~ <br /> / ~- - HEALTH DISTRICT <br /> � SAN ]O8hV]|N LOCAL <br /> - ' <br /> E. H. P 1''d8 Rev. 5M\ <br />