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FOR OFFICE USE: A"VCAM#N FCR SANITATION MM" <br /> Permit NO. A.,. <br /> tGhapslete I" Ttip1 '} • <br /> Date issued 7rjP i <br /> _ j.(/j..l .. . T1ds►sraiirinpkss 1 rearF,al Dss»Iwsed <br /> erre. ........_...... <br /> AppslimMen Ie hwobfl mods to the Son Joogvin Local Health District far a permit to conNfuer and Inttoll the work heroin <br /> ditcr"wd- Thl�oppt Is to n e with County Ordinance No, Seg and 0x1`04"4 Ruiee and Regula"Or u <br /> JCS ADD=10 f s- La .. .CfMA TUXT erre_ <br /> k xurn.4.�ns. .L� -� -��� <br /> Owner's Name ( <br /> .. _. <br /> Address a7 0`4 .i n[ " 7�•-% >.._.-._...... .. . .......... City <br /> Coniroctor's Nome .......... Lwnsa II/ l.'ipY_..- Phots .............. ............� <br /> lnstallatlsn VA larval Residtmee[J,�Aponmovd Nouse❑CotT11111116felal❑Rails.CauR ❑ <br /> IAolel❑Odw ...-........._.- <br /> Number of Irving un!W 1....• Number of bedrooms .. A...Gcvboge Grinder lot Sire o� des G�..I/!=............ <br /> Wines Supolir, PUMk S %Wn and na"a ,........_..__... .. ........_..._ . _ -......I-- . ..... .... .... .............. <br /> lrMsls� <br /> C hareci t of sell to o depth of 2 het, Said❑ Slit Q Clay ❑ reale❑ Sandy Loom❑ Clay Learn O <br /> Hwdpon❑ Adobe Fill Material H yes,type ............... ...... <br /> 1pfat pion, show r-g skis of lot, location of system to relation to wells, buddkgs, ete, must be plated on t0wrse side <br /> N1W INSTALLAT10Mh (No topic tank at seepage pit pwn%Uftd If oWk,wwwor IFW646b19wlrhen 200 fset,l <br /> PACKAGE TREATMENT ( ] SEP TICTAW I-11� Liquid 0"* ..44......... . ..... <br /> Copadty L 0.. . Typo Fi L • �- Maierkg� roc^^C .. No. Canpanmo wN ...i?, ......__.. <br /> DiDistancero <br /> to "eost; Well .......$_04--1 .. ......Fav+dallal ...LG. -. _. Prop. Line ..-. <br /> I•N <br /> LEACNG LINE Irl,+ No. of Lines _.� Wlglh of each line _ .Y�'./�(` .._Tad Lengo, IG.Q�.X....... <br /> 'D' box ,! Type Filter Matadol .... -5..R.......Depth Fanta Alareriai _JV.- ....... <br /> Distance to nearest. well �r k-T. ._. Fouitdorlon Property Una .. C-�........ ` <br /> SEEPAGE FiT ( 1 Depth .- _erre erre. . Diameter Nwn6es ...:... .+ _.. Rock Filled Yes ❑ No <br /> Water Table Depth ............. ..........hila sal erre . .._ ... <br /> Distance to nearestWoll . . .. ..................... .....WLmdoElon _ .,.. crap. line ....._- <br /> 111PAIR/AMMON(Prov. Sanitation Permit♦ ........ ..... . . ..r r. ........::-... Dass ... ....._ <br /> Septic Tonic (Specify Regvlrements) erre... . ...... ....... . . ...1.....:.~......'. ..... . _ .. .. ._..-.. ._........_._.... <br /> Disposal Field (Specify egvirements) -- <br /> R erre. ...... ... .......... .. _._._erre , . ............ <br /> (Draw existing required edditimt an raearto side1 <br /> — 4 and g .................... .. _.. -- <br /> t hemky certify thof t hew P*^parod *tis apPtic dim sed r <br /> that The eek wO be lora in s1Mad�hee udN 1M rsa,tlla <br /> Cow" Ordinances, State Lows, and Rvles Dad RyirtaNem er The San 1111 a Leval Houltli 01M010. Home -on$r K News- <br /> "d <br /> assod agents 64gnoture certifies the falfaw4ng: <br /> "1 certify shot in phs, Performance of the work Far VA94 Ntis ponaM 116 Issued, 1 shad) ow employ any person, la each mantles <br /> as is i»tomo sabiett to Workman's Coah'eMetlen law* of CoWernlo." <br /> S,gned Owner <br /> By lG4.i.+.t-d. ..Z �� . title <br /> !4t ott+er rltorh awnarl (! <br /> Aja DIPA ItAINT US1 OMY __ V <br /> APPLICATION ACCEPTED 8V ..._e. /, ✓ i!� •/e'.,i�.,.,, DATE }�6 <br /> bUiLDING PERMIT ISSUED / / DATE <br /> ADDITIONAL COMMENTS <br /> TCS, .Final lnspccr�en 6y .. Dole <br /> i)i 13 2(t 1-641 Rev. 5?4 SAN JOAUtJIN LOCAL HEALTH DISTRICT 8/7h 311` <br />