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� \ <br /> FOR OFFICE USE - APPLICATION FOR SANK�TION PERMIT `. <br /> Permit No.(Comp|ete in Triplicate) ` <br /> Dote Issued <br /> - ---� ExpiresThis Permit 1 Year From Date issued . <br /> d tm ��e �on Joaquin Local Health Di <br /> for o construct and install, work herein <br /> | c«+ i h is mode'in cmmp||onoa with County Ordinance No. 549 and existing Rules and uego/nnpnn <br /> described. This application <br /> �` =L -~^ <br /> '~.----_---^-----�ENSU� TRACT - ----------- <br /> JOB ADDRESS/LOCATION ---1'^'�'��v�� � 4 � <br /> Owner's Name -'A._ f�)E ' Q�|0 5 ' ' '_---,--'---'-'--Phone 1=� �.� .-9 <br /> Ad6reso ��� ______�'--------- ---------- -------------------------------------- City ^----�-------'--'-'--'--- <br /> Phone -------'--'' <br /> Con�ocu�'sNome ---.. <br /> Installation will serve: <br /> . | Motel E?^"'~~ -'^^---- ---------------------- <br /> Number of <br /> ---------------Num6erof |\v|nQ units,-.--,/----- Number| of-6edrmun�n -Li- .GorbogoGrn6er �l6�- Lot Size --~`^�.r-----.--' <br /> -''`--y. Public --'----Pr�ote ��--- <br /> \mo�o, ��ymem and n6me -_.---_'_-___--'_------_'_---' <br /> t. <br /> o��racter of �oi| m � �� �3 i ��� �� � ��� �� �� � �� �m � <br /> ~ If type . ' ' <br /> nJ Adobe 0~ FiUAa�d | � <br /> (Plot plan, showing size of lot, lo'cation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> artments <br /> ^ <br /> Capacity /2,00 ',,- -����� <br /> - - ^ ' <br /> - <br /> - <br /> -.-'m - ��.---- Prop. Una --------- <br /> Distance to neonouo Va.| I --'__-F�undod�n -� <br /> 1 �1--'---- Total Length ---1�__---_' <br /> LEACHING LINE No. r� Lines �'� .---.- Longth of each Una Depth Ghe, �u�adu\ -/^V.=__. <br /> 'D' Box J��-- Type Filter Wz*eho/ <br /> ��^^ <br /> / <br />� F�ondp+|o� -------------------------~~~- p�,�er�/ Line -----__-' <br />| � <br /> Distance to <br /> �*ck FA�� Ynx �] N� �] <br /> SEEPAGE �T [ ] Depth -.[--.-- Diameter ---.-- Nwm6� --------- <br />' ------------ Rock ^ --'--- <br /> Water To6|o Depth ------_'--'_'_^--_ -_--. <br /> ' -�ovndp��n Prop Unw --'-'_--_ <br /> Dimnncatnneoms� VVe | .-_-.__-__.' .---.-.. <br />| ID��w <br />| �m���rev 3mni�p�6hPermitv� -----�---.-.-.-.. '_----_'__') <br /> REPAIR/ADDITION --.--'___'-�-_'-'-'--.---__'_-_.----' <br /> Septic k (Specify Requirements) ----.--__--- _____________ <br />| 'Diaposo| Field (Specify Requirements) '-'------'-'-'-'--'----'-'-'-- <br /> . --.-_---_-----_' <br />� -'-.--.-----^--__------'' -------------------------------------------------- <br />| '--�-- -'--'--- <br /> � _-_--.--_--.-----.--. <br /> � --_. <br /> � ^ -���� o <br /> (Draw existing and required addition on reverse <br /> 11 be done in accordance with Son oaquinhereby certify that I have prepared <br /> ` n� Nw| and Regulations of n~m �m� ��=q°.^. ~~~~. Health District. ��o . <br /> � CounryOr6|nawces' �ateLmvvs mnm �� <br /> � <br /> sed agents signature certifies <br /> |� M`*f'm|� *|ng` permit i� issued, <br /> I mha_V| not employ any person in such manner <br /> ^ | certify that in mw performance of H� vm� f� w�ch �� <br /> as to becomi subject t Workman's <br /> laws of California." <br /> 7,,,ec" <br /> ( ---------------------------- <br /> (if other -- owner)- <br /> FOR DEPARTMENT USE ONLY <br /> / APPLICATION ACCEPTED BY ` _^~_/49-17-0 <br /> ---'----'-- --- -----.. -'-- <br /> .------'-----'----'-'- .--Do�o -��c�� -- --------- <br /> Final Inspection by: --'-'--'------ ' ' \ l^ <br /> ' SANJOAQ L `~ <br /> � <br /> ! E. H. 9 1''6W Rev. 5N\ ' . ' <br />