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I <br /> FOR OFFICE US& AMICATI 11 FOR SAWATION FEUIVIIT <br /> .........................._....._..................... hrmMNo. ..7........? °... <br /> 1co mplete to TAPnaM <br /> .........J <br /> .........:. ...............................4.......4.... Two Penh 1xielm I Yaw From Date N" Dote Issued.. <br /> Applk-Atlon is hereby taode to the San Joaquin local Health District for o Pwmlt to cenMtucf and Inaon the work herein <br /> described.Thle application Is matte Intm"Piloma with County Ordinance Rul <br /> �nce.No. 549 and eddb* es and Rapulaliona <br /> J08 ADDRESS/LOCATION ........ Jr...l -y....................!/..l.../lril. .. ............... TRACE .................,........ <br /> Ownrar•s Name ............VWZZ— -41...........RAVZW l�z.................................... <br /> ............Mtene............._..................... <br /> . ... <br /> Address ......................5`Q?LEL+...... .... ..../.l........................_.._.......City —A..E}�X•�� 0.1..............................r... _.. <br /> Contractor's Naar....... ,..1-�!••x•f•�.•r.l. ...._...._....»...._............lanae� S�S ��..-.. Plane . ►/�.�. <br /> Installation will•whet Residence W Apawnw*House C3 Contrast"C]Trdlw Casal O <br /> MOM0Othw......._.._......................--•-•• 9 <br /> Numbw of 1141" Ia.Rr......F_.. Numbs of badrooma�.•_Carbage tirlttder ............ LOON .....- <br /> Water Supply, Wolk System and name...-....._...... _.�._._........__..�..__._ r _._. <br /> Chosoc»r of awl ro o depth d S feeh Sand O SIB❑ Clay ❑ Peat Q Dandy Lawn qf Cloy Loan❑ <br /> Hardpan Q Adobe Q Fill M61WW............If V46- <br /> plat plan, <br /> es,Platplan. shown slse of lot, location of system in relation to wells, bull**% 0119. mat be placed an nnwM aide. <br /> ' NEW 0WALLATM. No s.Ptk tonica seepags pit Permitted N k-.sewer Is within 100 fes1J <br /> PACKAGE TREATMENT rJ SEPTIC TANK( I �hSim..:r/-�r�.�-Q�1.,X...6 .X...... Ltquld Depth ...... '. =. <br /> Capadry ............. Type .................... W............-._.._. No. Comportments .. - <br /> ....................................round~..................._.".Una <br /> Dlatortce to twaresh Well _�. ._._.. <br /> ING LINE t/i No. of Lines ......1ppth d each Iine......7.7�......... Tow Lwq* <br /> D' Box ...... ..... Type FilterMaterial ....................Depth flits, Mnterlol ......................... _ ... <br /> Distance 10nearest, Well ........................ Fotmdatlan ........................ FrepwM <br /> No <br /> SEEPAGE MT ( I Depth .................... DlaniNw ................ Numbw ............................ Rock Filled Yoe C3 <br /> Water Table Depth .........................._...................R0aSin.._.. _.. ..,_..1 ..... <br /> Distance to nsh Well ........................._........_...FowtdaItOn ..._.........._.. Trop lar ........._......__. <br /> wn <br /> REPAIR/ADDnWN(Few. Sanitation Permit#.................._. ........ <br /> - hePhe Tank ISPPeddfY Requirentenb) .............................._...... <br /> ......._....__._:..._.........._......_--»-.. , _ '. <br /> sDosal Held ISPadfy Requlrermnts) ......�.FJI?Fl. ...IFIL �.... .yt.+«•C :e�'J1J1GY...... ................... '. <br /> Oi ......d <br /> ... (Draw edsNng and required addlHon on rw+arte eldel - . <br /> I hereby carft that 1 sews prepared this opiencod" and thad the week wn: M deme la moss <br /> dease wish feel Jeehdm <br /> County Ordinances, State laws, end Rules and R.gulcilwts of tl..San Jeequia Used Health Oki".He"awaee Of"COW <br /> sed counts signature c"fos the following, <br /> ••1 certify that in the Performance at the week far whlew this P it is Issued, I shed 00 armPMY.guy Pont"M seeA.atwteer <br /> ac to become subject <br /> x t e / !.�. <br /> on'S o pensalion laws of California." <br /> �m ` � Ow <br /> n <br /> S.pnd .. ....C� ....... . 6 : ........................._.. . w L <br /> .........�q� <br /> 1,. (if other than owned . <br /> F02 DEPARTM ... USE ONLY q <br /> APPLICATION ACCEPT-D BY..... .............................. DATE..�r-T ...=... y7..........:'. <br /> -_. BUILDING PERMIT ISSUED ......__............................I.................... .................... <br /> .........................DATE-................ ........_.._ ......... <br /> ADDITIONAL COMMENTS — ..... ................................._.........._........................ <br /> .................. ......._......................................... <br /> ..... ................... .... . ..... .. ........ . ......... . . .. . ..........................................�.. <br /> ..... <br /> . . .. .. .. ._. .. ......................... <br /> ... .......Dat. . . ... . .. ... <br /> ........... <br /> Final In.Pecta- bY. . . .. ....... . . ...... ... ...... . <br /> ` fll 1J 21. 1-6H Hae. SN SAN JO IN LOCAL HEALTH DISTRICT 0/7L 3N <br /> �ti <br />