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,.0- r 4 - <br />FO OFFICE <br />- <br />FOf!ZOFFICE USE. <br />APPLICATION FOR,.SAWATION PERMIT <br />(Complete in Triplicate) <br />Tids Pal mit EVIres I Year From Date Issued <br />FOR 0 <br />fICE USE: <br />Permit No. <br />77 <br />Date issued..-1— <br />Application is hereby mode to the Son Joaquin Loco] Health District for a permit to construct and install the work herein described. <br />This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, <br />UJVL^ww )wt* i m Am ir fo <br />k6 CENSUS TRACT__. ....... ...... . <br />J013 ADDIZESSAOCATIOti.1 _1h . ......... js�_ <br />Owner's <br />IF <br />............. <br />' <br />....... ity. 444. &—tdo <br />Controctor's Nome....Cspone.. <br />....... <br />installation will, serve. Residents Apartment House �Commercial <br />-3 <br />$ Trailer Court <br />Number of living unitst_�. ... A....-Nurr0W40f.Wroams.,, -GarbtigaGrincter .... —.1.6a 14;"-...-.-.:-__.1_1_ <br />Water Suppi t PSystem stem'and -name.................... <br />.......... ­­ .............. . <br />Character of soil to q depth of 3 feet: Sand Silt El Clod C] i4 PeatSandy Loom <br />._iY P Pay Loon,X, <br />r <br />tei . . if yei, type....:......:..,_._~-,_ <br />Hardpan r Adolie)5" Fill Mor <br />" aj�...­ ..... <br />r (Plot plan, showing size of lot, location of, system in relation to wells, buildings,'etcrnusf be 'placed on reverse* side.) <br />NEW: INSTALLAilJON.' j(N6": septic' tank *6t we <br />page pi permitted if ;:�bli c sewor s available within 100 �eetj <br />PACKAGE TREATMENT I -"`-SEPTIC TANK f�)Liquid Depth ........ <br />Size.* ... ............. ............... <br />Capacity ... .......... .............. Material.......-... ..... . ....... No. Compartments__ ......... <br />'........ ............... <br />.Distance to nearest. -Foundatt <br />Foundation Prop, <br />......... <br />LEACHING LINE, No. of, Linea I' --w-,* I... ... ..... Le <br />... jotal <br />A <br />V Box .......... Filter ...... Depth Filter Material..... ..... t­� .. ........... <br />Distance to near;st. ...... I ..... Foundation..._ ........... _.._._Prop" Line,.:_... ................ <br />1 4. .. ­ . . I _4 I Z <br />SEEPAGE PIT Depth,_ � ....... I ...... ... . ..... . Rock Filled Yes 0 No'D <br />Water Tc ble"I!Depth___... <br />...... Sze ........... <br />.......... <br />Distance nearest. Well.", ..............Prise. <br />ItSiAlk/ADDITION (P4v.' Sanitation, Permit #....... .................. . . *..,_._;.;. -Dot <br />. ......... <br />Septic Tank (Specify Requirements).....,... .. . ..... <br />11_-____1_.4V ... . ..... <br />Dlsposol Field (Specify <br />----------- ........ .. ....................... ...... . ........ ...... <br />11)4w ixisgng and required 6ddition an reverse side) <br />I "by Cwtify that I have prepared this application and that the work will be done In accordance with Son J"uin Coun <br />Ordinances, Stat* Laws, orted Rules and Regulations of the San Joaquin Local Health District, Name owner or licensed *"Yft- <br />sis"aigre certiflos the fail <br />ow*q: <br />"I tertify that in the per"Anc* of the Worii for which this P'*rreft is Issued, I Mail net employ any person in $MCI* me nnw'asi <br />to 6WAMM SU61*d to Wwkmion's ComporumWon laws of CalltornicL" <br />I <br />Signed-- <br />....... Dwhtw <br />By- <br />------- - ­---------- <br />Title. <br />. ............... ... ..... <br />F04 DEPARTMENT USE ONLY' <br />APPLICATION ACCEPTED BYms- ............ ...................................... DATE.._- 6. <br />DIVISION OF LAND NUMBER ........... ...... <br />--------- — -- n.­ <br />�Z V <br />ADDITIONAL C0MME-t4TS___; .......... . ..................... <br />.... . .... . <br />..... . ........ ».«..»..... .... . . .. <br />........... . ........ . .. . .. - ---_--__ ..... .... <br />. . ........... <br />-. . <br />- --------- <br />............ . ............ . ......... ........«..........• ..... ------- - <br />............. ........ ......... ......... <br />EM 13 7A JOAQUIN LOCAL HEALTM DISTRICT O&S 21677 MV. ?/76 3M <br />