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_"v�"�i.� dl,Vlrt"'rtll�� Rar, wEf =.,w ,�tV�ld."I'll •�8.. <br /> F <br /> FOR OFFICE USEAPPLICATION FOR S/',NiTAT10N PERMIT <br /> ..... <br /> Permi4 l�a. .IS'.�-'��. <br /> (Complete in Triplicate) .•rt <br /> Date Issued iJ <br /> .,•_, „-,.. This Pernilt Expires 1 Year From Dot*issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to cons aruct and Install the work ham•-yin <br /> described. This application Is mode in compliance with County Ordinance No. 549 and Dating Rules and RsrJulatlor:s, <br /> OB ADDRESS/LOCATION . . .. '�O f` /• .... / Ph <br /> ..CENSUS <br /> one Is- <br /> r s . <br /> ChNnor's Name ....a TGv� . .. ._. 54r4 !�a. ............... .....' _ . .. <br /> ,. , <br /> Address /3//.J� �r/S.T�/r1...... ....,.....::CIty . 4,.x1 o5`."r.. '......._... •.. ..... ... <br /> _ n � <br /> Contractor's Name ._.A ......... ............. . ....License*e /..;"1w . Fhor+e <br /> Installation will serve: Residence Apartment House f`] Cofnmercial ❑Trailer C• t:r°t ] <br /> L Motel []Other.................. .. <br /> ..... .. <br /> _ •'. Number of Irvrnq units:.... Number of bedrooms ..5k...-Garbage Grinder .::._.... .. 4.,, Size ..� . <br /> �i Water Si Public System and name .........................................,.......----.._.. . <br /> Character e'soil to n depth of 3 feet: Sand[] Silt❑ Clay [3 Peau[] Sandy Loam i lay LiNmn 0 <br /> Hardpan❑ Adobe L3 Fill Mater al _......... .If Yes, • .... <br /> r <br /> {Plot plan, showing size of lot, location of system.in relation to wells, buildingsete must be placed on rovatss� <br /> s�•�„ <br /> NEW INSTALLATION:" (No septic tank or seepage pit permitted if public. sewer is ovorlc ble wi¢hirti 200 feet 1 w <br /> — i SEPTIC TANK I ] Size....................... ...... _...... ..._. Liquid Depth = > <br /> PACKAGE TP.EATMENT [ , <br /> Capacity t nearest: Type <br /> MaterlaL............. °da. Compartments . <br /> pY ........ .. .... . T .. <br /> Distance o ....... Foundation .. Prop. lits ••i- <br /> ............. <br /> u..' . Length of each line.. ..... Tota! Length ......... <br /> LFACHING LINE ( ] No. of Lines ...... tj <br /> Dept� Filter V''Jeriai .... <br /> •p• Box Type Filter Material .... . .. ... ..... <br /> .. ..... Foundation <br /> • p,�ry Brie ....,r:' ........... • <br /> Distance to nearest: Well . ....... , KA3 <br /> Diameter ............ ... Number ...... .... <br /> Rock Filled Yes <br /> [ Depth r <br /> SEEPAGE PI <br /> Rock Size .------ <br /> vJoter Table Depth ....... .. ..............:......... <br /> ......................Foundation .... - <br /> ... Prop. Line .------------ . <br /> Distance to nearest: Well .............•. <br /> EtEPAIR/ADh " <br /> Date ....... ....... .. ... ......) <br /> DITION(Prev. Sanitation Permit # -- t <br /> 1 <br /> Septic To {Specify Requirements] <br /> r� <br /> i Requirements) .. - � ��- ��- <br /> Disposal Field (Specify uirements <br /> q . ._._ ...... ..... <br /> .......... <br /> •-•• ......... (Draw existing and required addition on reverse si el <br /> rk l be <br /> cern that I have prepared this applicntlon and that he n Joewuin Locaf®H(a6 h IDIi,Mtt Hertse owl r'. <br /> 1 hereby fY a Son a <br /> ' County'•Ordinances, State laws, and Rules and Regulations of th ���sYQ1s etstnn+� <br /> fed agentthagin the performance of the <br /> for <br /> which haws ofthis <br /> G Permit <br /> is Issued, I shall not "4"01Uy any P <br /> P <br /> ens <br /> "1 certify nio.' <br /> as to become 7b, to orl! an s Co p <br /> cOwner <br /> Signed'_". <br /> Title <br /> By. ,-.. . 4. <br /> (If other than owner) T-OR DEPARTMENT USE ONLY <br /> _ .�.•. e..,,,:.�m°,� DATE <br /> APPLICATION,...,,_.., .. <br /> , �, DATE • <br /> � ACCEPTED BY �`•`� _ <br /> BUILDING PERMIT ISSUED <br /> ADDITIONAL COMMENTS . <br /> Final Inspection by: 8/7h 3M <br /> _ 1-G 3 ' Ct r� J tO�r,Ultd LOCAL I T <br /> HEALTH 'R'C <br /> 1J_2L `` VMI puiim ll•'.G ru , a^n.•�;i, V iu�r' D$ <br /> .�u, <br />