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- <br /> ."" `°"`""S= ` <br /> lr CATION FOR ' <br /> -----' _z �� <br /> (Complete in Triplicate] �o,�hN� <br /> ' ' V-7 -21~ T6� " ^��~��" Do*e |o*uxpires I Year From Date Issuedod <br /> Application hereby made ^oNhe/��� Jooqu|n L�col Health District '- <br /> for o � consNo truct n�u� ond installinstallworkthe �,k hereinoespnuep. This application |snnode |n oomp/|un�evvith [nonty ��rJinonce ' 549and existing Rules and 8ego|pti ^m <br /> HardpanV ........B'D-----------CENSUS TRACT ----6-570 <br /> Owner's Name fz-. Zn <br /> Installation will serve. Residence E]Apartment House O-Commercial oTrailer Court 0 <br /> Number of living units:------/---- Number of bedrooms __Z_Goibc�ge Grinder <br /> Character of soil to a depth of 3. feet. Sand 50 Silt F] -Clay [I Peat 0 Sandy Loam 0 Cl2b1A0am.Z] <br /> �&m <br />� __ �~ _ ._�__ `°�°~ , ,~" ',pe <br /> (nc* plan, ohovv|n8 size of lot, location fsystem i relation o� vveU � <br /> o, buildings, etc. mvvm be placed on reverse <br /> NEW (No septic tank or � | M�d if public �we is available within � feet,) <br /> '�-' �m <br />� PACKAGE TREATMENT �� <br /> [ ] SEPTIC TANK ~ Size--------- � ._ Liquid Depth - ---........ <br /> Co /�0-0 % wNo. Compartments _' - <br /> e <br /> istance tneo,oyVo � <br /> --'_ � �--' -'- _ ` ----' Prmp. �LEuCHUNGUNErl~ Nu -'- -_-- enQ2^0-1'—'_- Total Length <br /> � <br /> 'D' Box ---_ Type Filter Materia| ����'�� R� ��| �� - -' ' � <br /> " � -----_. -.� <br /> _ 1onegre�) VV*U Foundation �ne <br /> 3EEP�GER? [ ] Depth �k�n�o�er Number' Ro�k |� -- -�-- <br /> _ _--^'--- '�-'_'-- o --------------------- ------ Filled Y*s <br /> ' Water ?o6|e Depth _--�'-----_--.'--- '--.Ro«k�z* --_.�'-_''''--. _. � -- <br /> ` <br /> Distance to nearest. Well -^__'--'-'-_'-__Fqwn6ation -_'_-^- Prop. Line - <br /> (Prev. SanitoMonPmrmh# —___'---_'_' ��+� '--'_'' ----------- <br /> Septic <br /> Ton� K�pecfy Requirements) ----.-_-_-----_-.-'_---_'---.._ <br /> D0spomn| R*lJ (Specify Requirements) -.._-__-----'_-_.--'_-_--_-.-�'-''----_.------_-.--`---' <br /> � <br /> -''----_---__-'--------'_�_'''----''--.---`--'---_'�-_-_-'-_'---_._-_-_-------_--_'_'-- <br /> -'''_--_----._'-'_._--_-_----- '_'-'_'--_'---'_-----'' - � <br /> UD,pvv��o�ngand ,nqo�e6o66�ononrevameo�n '------' '-------''''--'-'-' � <br /> U hereby certify that U have prepared this application and that the work will be done in accordance ~� � Joaquin <br /> �� �i�� S� �� a� �� a� �m�� of � � J�� L� — � �� �~ � � � �� i <br /> sw6agemt* wignatqrw«e��ywmt6e following: <br /> ''-- ~~~� owner° ! <br /> ^'U certify that in the performance of the work for which this ~erm|t is issued, U *hall not employ any person in ws manner <br /> as to become subject laws ofCalifornia." ~` ~-~ <br /> Signed ---... ��m�, � <br /> _--_'-_- � <br /> By <br /> ------- - .. -= =,, =r- --------------- ---------------------- Title <br /> Ufother than oown�� '''---' ------''---------'---','- <br /> |' <br /> APPLICATIONFOR DEPARTMENT USE ONLY <br /> ACCEPTED u, ------�.�xn^ »�__ DATE <br /> BUILDING PERMIT ISSUED ------------------------------------------ <br /> __- ------ ---'----'---'-'----''--- <br /> '^~' "�p=".w. .^—_._'---.--'_Do�e - ^^�� ' <br /> SAN JOAQUQN LOCAL HEALTH DISTRICT <br /> EM. 9 l'\68 Rev. 5N\ \�/7 U <br /> -,° / <br />