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'FOR�OFfICT U6E: .es. APPUCATf1ME RM SANITATION PRIM <br /> 76— Giy <br /> ICeemphae M TripNmist <br /> ._.......__........_......_.... . . ... - Dane Issued ..y')':�` <br /> _..__....._. »_...........__........._«—. TMs Prensdr tutpMee 1 yew Prom Def Meow <br /> 'r- Appikollon h haolT.Mode to Ow Son Jaoquin Local Health Distrid for o pWwJl b cendnid and Install the work hstMn <br /> described. This application !s made In compliance with Counsy�/Ordlnor�p NO.. 549 and SKIS 9n9 LA" aid Rpubtle M <br /> JOB ADDRESSAOCA L9r/ .�...rte:.. ,GyCy4� � r..._.-..r aWM TRACT ... _ . ._-... ... .. <br /> Owner's Name ' w_ ......_L.L+Mra•/'s•.- .............. _ _ Pixar .._.. <br /> SAddress � ._...... ...... ,,.......« _CIN . .... _. . _._ _. ._._................ <br /> Contre"'s Nome Pulmo .__. .. .»..« .. .«"N <br /> Installation Will serve; Residsgp❑Apace NOUNQ CAraowdd QTf04W COW O <br /> MGM 0 Other <br /> Number of living unite ...-J.. Number of bedrooms .F'_..OasbaW AslrA ............ Lal$I= »13._�.........................��! <br /> Werw 3upplyc Public System and name .., . .. ......._...._.»........_....................._,......__--............... O O� <br /> Chorocter O soil ro o depthof 3 foal sand❑ SM(3 Cley O Pem❑ Sandy Loan O <br /> Hardpan Q Adobe Q FlIlMaWW ._. . . ..N yos,type..........__.------- A <br /> IMat pion, $itching size of W. location of system M nlallon to WWII, bulidinge, at Mime be placed on reserve ddQ` <br /> NEW IIWALLAMNn IN* septic sank orsee pit permwed N public sewer is avollable within 200 140A <br /> i PACICAGE TREATMENT I j ( Slee.„..., ._..«._.. .._..... Liquid Depth .. ....�. <br /> i Cape .. . Typlylirr..ee/ .. MOWW Com. C444 _ Na CoTporlmsnh <br /> Distance to neoresh Wei Prop. <br /> yF <br /> LEACHMrG LINE (Y�/No. of Lines . �.__..___., length of Bods tine �`g VTCdai Length <br /> D ter <br /> Box ol(d Type Filter Maia) / '=C ., Mprli Filter SAelerlet l nfC.a........!_... ..�V <br /> Distance to nearest, Weil .A.10�Y . Foundation cX P... . ..... . Property UM ...` ..__...«» . <br /> SEEPAGE PIT ( ! Depth 'Y 4... . Diesmobr �.X Number, / ...... Rack Filled YM &-'lfo Q <br /> Water Table Depth ......... .... ............_.......-. ....._._.Rock $ite . .. .. . . __... ... ._. <br /> Distance to neared.Wile_................._...................Foundollan . -_ ._.... _ . hop. Wo .....» _, <br /> REPAq/AOOMM IProv. Sanitation Ps.Tit+« «.._............. .._..........._ Date .,.»..............e...........A <br /> SepticTank ISp@Ofy Requ:remienri) _. ............ ........,....».........._._.................__...._._�_ ......_.,,,..._. ... ...»_._.»»... ..... <br /> DisposalField OpeeNy Requiremer" .._.--------------------.,...............-...._,_ ........ .-......... -------.................................. <br /> } <br /> _. ...................................... .......... _..._.. - ._...._ - ...._._......,............._.... <br /> �rattr aohNsq and required addlllas an pulp sldal <br /> I herby Certify thud 1 haw Impend Nis appRoo0m awd ober tb wort wig be dews M eONllklee w1Mt fess JegOM <br /> Cerny Onlinanees, Steve Laws, and Rules and MpdaNem of Nu San Jewq 1 teed NedRt 81MNR Molal ewwa►or Esso- <br /> sed 0900011 signaWre CWKfWs Me fellewLW ._ <br /> "I Certify 1401he far wfslcb IWs Psswth 4 issued, 1 skelf acs 0 PMI trey persists in sed seetiee <br /> at N beceeie 1v se W laws of CoWeinle.” ` <br /> &gnod k Owr W <br /> By ],tie ' <br /> III other than awnerl <br /> —PW DEPARTMENT I= ONLY <br /> .... ,moi �,_ _..._...,...,._ <br /> APPLICA►ION ACCEPTED BY DATE cS'-3�a�.7tS <br /> BUILDING PERMIT ISSUED DATE <br /> ADDITIONAL COMMENTS <br /> Final Inspection by. ... c-y�....r .�� . .. Date <br /> EN 13 ?L 1-6R Acv. 5m SAN )OACWIN LOCAL HEALTH DISTRICT 8/7!t 3i1 <br /> r <br />