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{��gCE USE- � . <br /> FOR APPLICATION FOR ���� <br /> °, �:���~~^^�^` PonmkNa <br /> ' '-- �� ' '. Nonmp�+e[n ?�pl�mt� <br /> --------/ i���' <br /> Date (nxwe� <br /> - z" This Permit Expires I Year From Date Issued <br /> Application made Local Heu|�� �|mz|c+ for o |t to construct and install the work herein <br /> described. This application is m CoMl1an9qwWa_Lo, ty' ~'~~� '''~ OrdinancelNo. d existing Rules 6 Regu|oMwno 1 <br /> J(�� �oow�uu/�o�*nNSUS TRACT � <br /> Phone <br /> . Apartment_ _' -_-[] - --^ -..~..~. ~. _ ' ~~,~. ---__--$ <br /> Motel [1Other -'-�-_'__------- <br /> `u^ ~~ of living unite' -- Nomber of bedrooms '----]Go,6oge Grinder at Size - c/ <br /> ~^ <br /> ~� <br /> ~�'- <br /> -- <br /> k 0--'PMwo+eNote, Supply: Public System and name ----------------------------------------------------------------------------------------- --'- <br /> Character <br /> , <br /> of md| too depth of 3 feet: Sand'[] 0KClay E] Peat[J~ Sandy L6c1m Clay Loam :E] <br /> . ' . <br /> Hardpan F-1 ~~~~~ <br /> Fill(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if.public sewer is available within 200 feetJ <br /> ,"°~"G^ .,"`,,,",. / ] ~^. .~ .'.,.` p' Size- -------------- <br /> Capacity 120w^'— '' ^�' Material-°~�"----- ',- --',p-r--nt� ~ <br /> . � ' ^� ��� � -' ` <br /> Distance to neomu� VyoU f���-_-_-_-_FovndaMon ~^��.---.- Prmp Une '*���.~��'..`_ <br /> LEACHING <br /> 2 No of Lines A L6noth of each |i Total Length ^ <br /> SEEPAGE PIT Depth �7 -p'1 ^ ;Z---- Yeo No <br /> Rock Size <br /> ^ ~��_.� \ <br /> ' : Wei , Line �"'cp�-----'Distance to ` <br /> ----------- <br /> Septic |onx (Specify Reqmven]*nr ) <br /> _ �-�---------------------------------------------------- --------------------- -------------------------- <br /> `---- <br /> -',�---__--_-_--.. <br /> Dispomo| Field (Specify RequinerKents) ------------_—'_-' ---------------------------- —'—'--'-------'---'---- <br />� -'--^'--�------._-------__'_---_��._'__--'_'- — <br /> -------------------------------- <br /> --''--—�—.--_—'—�_._—_._-_—'--��-_-_.------_--__-_--_ ------------------- <br /> (Draw <br /> -----' <br /> (D,ovnxishng and required addition on reverse nide) <br /> � <br /> | hereby^ *erGfV that U have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Omdinmnneo, State Laws, an6|RmYem and Regulations of the Sam Joaquin Lmwm| Health 113istrict. Hwmme ow,nm, or licen- <br /> sed agents signature certifies the following: <br /> certify <br /> "| certify that in the performance of ' � for which permit is iommw6, U shall not mmmp]� manner <br /> �m� �mm»�� ;m mw*� �mmw� <br /> as to become subject to Workman's / ��, vvUw� �|�fm, 1m.° <br /> OwnerSigne6 ' <br /> ,,:,,opon ti../ <br /> o?than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---..���_--..�-.�_'--___---_--.-_- u�/� -..`�—.=='—.,` -_—. <br /> BUILDING PERMITISSUED ' DATE ------------------------------------------- <br /> J <br />. <br /> --.-�.---_ <br /> --'—��-'-----' ° = ' <br /> x <br /> .__ <br /> ---------- <br /> -------------------- <br /> Final <br /> |nspec�onby ---. - �..--'__---_----_—.------Date -- <br /> SANJDAdU|N. <br /> LOCAL HEALTH DISTRICT y ' <br /> ' <br /> E '68 R <br />, <br /> E. H�`\9 l' Rev. S�` <br />