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<br /> 1
<br /> FOR OFFICE USE
<br /> APFUtCATION FOR SAWATION PERM 7�
<br /> �._ Permit No. . .
<br /> (Ceseplete In Triplicate)
<br /> Date Isaued ... 3
<br /> ., ..•. :... This PerrrrIt Expires 1 Yea►From Date Issued
<br /> a
<br /> Apphoation°is hersby;mcde to the n Joaquin Locol,Health District for a permit to construct and Instali;the work heroin
<br /> described�This�appikation is made in compliants (th County Ordinance No. .549 and existing Rules 6rWRegulations,,
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<br /> ADDRESS/LOCA _ ` , :.. l�y-zf a rti/S.�C„ CENSUS TRACT
<br /> . n� NarT1f�Y a ��. a 1. ...._.....................................................• ... ....Ph
<br /> ....�� Y or1e 7
<br /> tractor's Name' irr �l ��..s/; .......................License sF�.. �y-'- ... Phone
<br /> t t.: �. t4xz _. va.
<br /> installation will serve,' Residence 1401 rtment House❑ Commercial E3Trailer Court.0
<br /> yr
<br /> um`✓ of Nv • ..Motel pOther ::...... ..........................:....... n Y
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<br /> ing.unit�, Number of bedrooms :._._Garbage Grinder ............ Lot Size .... ......... .. :. o
<br /> Valor Suppip Public System and name .... ..... ....... ...._........................I. .._...... ...Priva2c
<br /> Chaiacter of Full to'a GQ th'of 3-feet, Nand Silt � Clay Peat Sand Loam � Clayfoam � �••t;3;�
<br /> Ji►t D r ❑ ❑ .... r D - D
<br /> i iardpan[� dobe Fill Material_ If yes,type_
<br /> " (Plot,plan showing',size or` lot, location of system in relation*to wells, buildings, etc. must be placed on r r
<br /> NIrW WSTALLATHMi- •(No septic tank or,.seepoge pit permitted if public sewer is available within 2W feet,}
<br /> PACtCAGE TREATMEPJ
<br /> T ( ] SEPTIC TANK[] Size........................ __... Liquid'Depth ...:. ..
<br /> Capacity Ty ..._ Material...... ............. . No. Compartments ..
<br /> Uistnnce to nearest, �iVoci .....................Foundatwn ...................... Prop Lina-------------------
<br /> LEACH ING
<br /> _LEACHiNG LINE No, of linos
<br /> ..._ .. -.•_._ length of each line. ................... ...... Tocol length :.-.- .. ............
<br /> ' l Ta' sox ..... ._'Type Filter Material ....................Depth,Filter Material
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<br /> k:' 1
<br /> lUisiance to nerasea: LVe11 ....._.... Foundation ..-.._..-....:_._...... Property Una. .................
<br /> SEEPAGE-PIT'; [ J Depth Diameter Numbe. .................. Rock Filled Yea
<br /> Water Table Depth ....Foundation
<br /> Size .:.... ....
<br /> ' Distance to nearest. iVe ................:..Foundation ... ....._.:.-... Prop. lln�c " V+
<br /> it .. --._... .
<br /> + VIII/Ai;DWTiON(Prov Sanitation Permit r ................. ...... ......... Date ..................................
<br /> eptic'Tank (Specify.Requireniw l _.. ........ ....... ......._.-......................_.-......: .....--..._............. ._.J nts) _ ..:G9.:: 1 4 ......� - ..:
<br /> 4.a}wwl Field {Specify Requirements)
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<br /> ;;_::.[!�T................ � 5 .... .c.Y...-� .-...;T�••..................................................x ................ .._...... . .--••-•-----... *y
<br /> .... . . .... .... . .. ..__.... ...... ..
<br /> (Draw existing and required.addition on reverse side) `
<br /> .«, •�k, that l Imwe pmpoci ed.thls appllcation aneI that'tho work will be done in oceordance with.Saus t '
<br /> ,Oesinait!ets,.Stale'1®wsi orad Rules'and RepulaHotts!of tso San Joe�uln LocaO lleaBth ®istr(c' Oierto0 vsrtl®I,
<br /> ate° ri certifios floe foliawin8.;. ,
<br /> 1 sx+rllflr�M dr.; rfectnaeoear of fhn`vvor8c for which this permit is issued, 1 shall not employ any �@rron i� av�ls
<br /> .�
<br /> b)bpc ,aubNc!fio Wortcw►on's Compensation lases of California.,'
<br /> �A w+dy,�
<br /> 6�V'moi^Se,,y -'� ^!�6•�..{/♦� .t✓�
<br /> yy •.: f, -"t ` (If other titan owner)
<br /> ............... ,I
<br /> fu�'IRA Al!►dT USF C:(dLY r ^,
<br /> Ct APPUGgTION..ACCEPTED 13Y cs� t'� DATE /�7 .2 4'
<br /> * pU1lpING'PERMIT ISSUED ....................................... ........ DATE ..
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<br /> ..........................
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<br /> rr ;tir rte••• .: , ..._a - ...
<br /> rwFinal Inipect L'Y:G �` -. Dote
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<br /> jp� ........
<br /> cr Y 1[�k 14i
<br /> t< ; tir ti SAic 1C+AQUIN LOCAL HEALTH DISTRICT
<br /> r,y r� vX+�:inti :. '. • _ - � -
<br /> �;tResa,';)M
<br /> .�3 •'+ 'may�+1 K• KyI',
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