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CE APPLICATION PERMIT /� <br /> - � ~ Rmm� Nu&������/ <br /> ~u�~=� �cvmp|mme]nT�p�wmm» - � <br /> Date |youe6 �/� ���' <br /> Thir.s U Expires YFDIssued / <br /> Application is hereby 6 to the Son Joaqin Local Hoo[H, District for o permit to construct and install the work herein ~ <br /> described. This appli tionir' MQ(16 in complicince with County Ordinance No. 549 and existing y)es.0 Regulations: <br /> IV 101C CA� 07fAv SUS TRACT -------------- ------------ <br /> Owner's Nome's"A-94. <br /> Installation will serve. Residence.E]Af <br /> Mo <br /> VYoterSupply: Public System and name ---------------------------------------------------------------------------------------------------------------Private [] � <br /> Character ofsoil toodepth of3feet: Sand'E] Silt Clay M Peat E] Sandy Loam �E] Clay L��< ' <br /> Hardpan EJ A6ob~�n� F|UN��tero| -------- � ---- ---- <br /> yey' Yype . . .. <br /> ~ , . <br /> (Plot plan, showing size of lot, location of system in relation to well0buildings, etc. must be placed on reverse side.) <br /> NEW (No septic tank o, seepage pit permitted if public sewer is availablewithin uoufao,J <br /> R�CM�/�2 ?REAJAAGNT --' Liquid Deo�� - «�-���^"-_.- <br /> Copodty Type . Aot*r|ul No. Compartments .�����' <br /> --''- V—' ' ", �� <br /> Distance to nearest. Well --../ - ---_-.Foundo�on --1-�---_ Prop. Una .. 5-`_-_-' <br /> LEACH|NGUNE )< No. of Lines ----3 ------- Length ---------- ------- <br /> Tu�o� Lo�o�� ' -_-- (\ <br /> 'D' Box -../-- Type F||hyr Natero\ _D�pNh �|�v A�oYe,kd ..^� ��-*~ --_'-''_''- ' <br /> / ^ * <br /> Di �o nearest: ./.���-_-- Foun6omk�n -'����.—.—' property, Line. .c�-----�-' <br /> SEEPAGE PIT [ ] �� Diameter �m�� R� �|� Y� � � 0 <br /> ---_-_---_- ����`1�����--� ._--'—' ---.—'--- <br /> VVoter Table Depth --------------------------------------- --------Rock Size -------------------------------- <br /> Distance <br /> _-_----'— ^ <br /> ` VVaU Foundation ' Line Di�once �oneore�. �������--�--.-_.--_- o�on ------.. Prop. ---'_----' ` <br /> (Prev. Sanitation Permh# ------- Date ---------------------------------- <br /> Septic Tank <br /> '—_-_--'_'-]SepticTonk (Specify Requirements) " <br /> r-a v e- i s-_t i g uired addition on reverse side) <br /> I hereby certify that I have prepar�d this application and ti��tlthe work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, mn� Rules and Reg ulaticmw' ' <br /> _ licen- <br /> sed agents signature certifies the following: <br /> � <br /> "I certify that in the performance of the work for which this permit-hr4sued, I shall not employ any person in such manner <br /> as to become subject I* Workman's Compensation laws of Ccilifor�la. <br /> - ---_--.. � <br /> o4ther tha wner) I <br /> FOR. DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY i <br /> *vD///um*L Cuoxxxcmm --.—..J-- �- <br /> --- -----------'------------'-- -'----T--'—'------------'-- —'- <br /> - �-------'------------- --k'---t~'------------'----�~�`' ''-'Rno| |n�poc�on �y ''[ .. .__ - T'� �'' ,__- -Do�*� - ^~�-�� � \7R��-- --- <br /> ��-- -'~'--- ' — '------ r--'----'' ---------`�--- <br /> ` <br /> SAN JOAQU|N LOCAL HEALTf DISTRICT <br /> . � <br />