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d <br /> IV <br /> FOR OFFICE USE: s ": <br /> A"UCAMN FM SANRATM PEWfT <br /> 7 <br /> Prhvremk .... <br /> (Complete in 1rdpm*w <br /> .... .. ........ ............. shh tMwmitgspba t rrar Frrmer Detehewi � pate hhemted A � x ��} <br /> . a <br /> Application is Thereby mode to the San Joaquin Looal Health Dlsfrkt,frtr o permit to,corhshhiv and InstleM ' <br /> described.This application is made in camphor <br /> wiMh County Ordiewnoca.''.f#9 end. �end w <br /> Cf <br /> JOB ADDRESSAOCA l 71tACT �... <br /> Owner'! Name -1--.__._"g3 <br /> Address - � 't1s " GMy_ - <br /> r, Contractor's Name ....,. A-. L'- kwm*.,�����r.7..� 'PT►�ne ����.. '.... <br /> Installation will serve: Residence Q Aparihthent Flonti ] C7TeelferCoititl' <br /> Motel❑011ier.._.. �..�..� { <br /> y <br /> Number of living units.... '.).... Number of bedroarns .-.� ...Garbope Grinder ,-. ....... Lot Sire � _-4A.•-.-'' <br /> Water Supply: Public System and name, ............. .........................................._..........»...._............ _.».PrMot+s � ` <br /> t` Character of soil to a depth of 3 feats Sand 0 Silt p Gay ❑ pow© Sandy Loans{9Cioy Doan© <br /> t Hardpan❑ Adobe Q Fill Materiol..._........If yes,type»»........... ........ .. s ` <br />` (Plot plan, showing size of lot, location of system M relation to wells, buildings, etc must be plaeed an reVWW Side), <br />&l NEW INSTALLATION: [No septic tank aitled N public saiwrr is avo0able wtlhln 200 frsf3 <br /> e l�Pan'► ,P//� <br /> PACKAGE TREATMENT [ } SEPTIC TANK to r........ Liquid Depth ».T........»......». ! <br /> Capacity ..,?o e.eq, Typ�A_r. cid Mcillriel ( z .. Na. Compnrinwrif: .s ...:.. .....J�V <br /> 3 Distance to nearest: Well ........; .CP ..........Fearndation .,/i7 Prop.Llne.. <br /> rl LEACHING LINT: (►� No. of Lines . ...... -...:..... Length of each Ilne.........P.41'e':_. Tota! Lermth <br /> 'D' Box ....1..,.. Type Filter Material Filter Material ....IV. ........... .....m ���, <br /> Distance to nearest: Well ......1� .. Foundation ..../� .:. PropeAy tAhe ....�� .... ` <br /> SEEPAGE PtT [ ] Depth Diameter Number ............I--......... Rock Filled Yes [a No Q <br /> Water Table Depth ...............................................Berk Size............................. <br /> ... <br /> Distance to nearestt Well ........................................Foundation ................. Prep. tine ..................... a _ <br /> i REPAIR ADDITION Prev. Sanita•�cn Perm it0 .:.. Date <br /> Septic Tank (Specify Requirements) <br /> P <br /> t <br /> Disposal Field (specify Requirements) ... ... .........................:. ,................,..................... ........ .........---- <br /> N <br /> . ................... . ,..,................. ............................... <br /> ............... <br /> ........................................................... <br /> .... t a <br /> ... ............._....................... ... .....................I.. . . ..,.............. .. ... naa� <br /> w <br /> ' "s <br /> Yt (Draw existing and required additioim on reverse side) ,. <br /> 1 hereby cern that 1 haw arae! this application and that the work will be done M aaadssae with Sew Jeac ��;�_: <br /> �= certify PTeP PP ob " , <br /> t, County Ordinances, State Laws, and.Rules and Regulations of the Salt Jo"vin Load 119M DNMd.Neuse eswrter w(ieaur <br /> sed agents signature certifies the following: � <br /> "1 certify that in the performance of the work for which this permit is issued.1 sl"A not enmploy grey person In such mal"M ` <br /> as to become subject to Workman's Compensation laws of California." , <br /> YSigned . .. . . .. . ... ........ ...... ...... ................ Owner + . <br /> I ' <br /> By - .. .... u w. Sit e r <br /> (If other than ownerl i <br />