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FOR OFFICE USE:
<br />APPUCA'1'li3N FOR SANiTA M Pim'"
<br />..;..».,............. _.., lCen�plete in Trac taihlr Permit No 77- • 5 �
<br />This !'eant Updru 1 Yeasril4t M Deft �d Oalht fau�td ..�� .2_� �.7
<br />„'plication is hwoby matde to the San .ruin Local Health District; for a p0mit to con#rudf and Install the woe hool a
<br />described, This application is made in compliance with County Ordinance No. $49 and a irli»g Rules and ltopulatWim
<br />` JOB ADDRM/LOCAT .. - ? 1'?� 1 ., . .,....... :............... ....:............................,....,,...,
<br />Owner`s Name....0 , .. .. .................,., .,........ ., .Frons
<br />'o/^ uJ,..�.t .......�ify :...
<br />Address
<br />............ ...........,,, .................: .
<br />COti#ractar's fVaane ... .�Ir�j�� ���7r,,,y`� ??';
<br />Installation will Serres Residasnco eApartmsnt Hawse0 Comrnwdli Cow Q
<br />Motel p otfw .......... ................
<br />Number of tivlrg uraitt ....,, j... Number of bedroarns .::/.. Last Sfss>....................,,...,.,.,...,,,. .
<br />Water Supply: Public Sy xt0m -i i .... .......... ....,,...........,.....
<br />rutd name ..............................................
<br />a•
<br />Character of sail to a depth of 3 fees:1 Saend E3 Slit C3 Clay 0.. Peart 0 a o Clay © i
<br />:Hardpan 0 A&bs, >=lll hi *Iwktri ............ N ice. ................ ..... ...... } �
<br />(Plot pion, showing she of lot, Will" of system W etc nhow be plat" of rovem 111411.)
<br />NEW WSTALLATION: 040 Sepik tcalaak or e t
<br />a seepa g pi pWrmittatd if�ictower is avoilablo+within 200 feet,) s ,
<br />PACKAGE TREATMENT 13 SEPTX TANK 5i�ea�`' .�',l>"?'.�:r'`a .................. L140W. t *P* ,.I.V.................. � I
<br />Catpadty ll,'V . Type / �:�_ 'Matwkd ... Na, Compaxttnsrtih .......
<br />.,...
<br />Aima►. to nearest, Well�t',.e�i?` "». , .,,,..Fawrta� ,.... !� .. Prop. Lute ,. "�ys..... 01
<br />UA04WGLINE W. of Liras .............. Litrtth of.east llra.... Triol Length
<br />'D' Box ....1..... Type NW i+arterial-•......:-�7.',~> ....IDepth filtar AA+tlteridl ...../.' ..........,.......,, ,
<br />woonce to' neaaatsts Well ,...l�? � Vic'" :, _ Fourtdatian ....... Pr Lissr ,,,.
<br />... �� opmly
<br />SEEPS PIT (J� ikeTafly ...._;Z4: 0kvneter f4umber .......... 3_ ,.,...,-.. Rade Bill Yes Be" No Q
<br />Water Table Depth• ................. Rock Size
<br />Distance to mwresh Won ...... �,a�'` >:....... ...Foundationt` _..�:+d,.��. props. r
<br />REPAIR/ADDITION (Pts+v. Sanitation tPermit * ....»........ .............:.....a..... tit►...a......,.,_..,,,»_.»....,._..� � �
<br />Septic Tank (Specify Requirements)........, ..............«,...,........ .....:..,. ... ..�..... .»,.:,�.., ,....,.,..... '
<br />Disposal Field (Specify Requirements) .........:...............;,r................................,....> .. ...... ..,.. ::.,..,..,..,....x
<br />................ ..................................... .--........................... _................... -._..............
<br />_ .,....,...».,..,,.,.,.. ..,.....................»..,.
<br />................................. _.......>.................. ........._..... _.................... ........... .,.......... ..
<br />........,_.
<br />10raw existing and required addMon an reverse side)
<br />I hereby astrtify that I have praapa rid this app orad that *0 weeks wM . be dews( In gq¢ateraictm*' vtri* Scan .0weiiWit
<br />Coauaty 0" Mssr►M, 5101e Laws, 004 RAPS and Rer*rAens of tbs SM .t "WA Leaud MOW* lals#r O. NON* ON ear
<br />sad oget is signature relftes the h4iwings
<br />"I certify rust in char performam* of tiaa work for which" permit tax (soar", I Susi.. net evoosloy any pawn in svA memo
<br />as to became sarb(ed to Workman's •C misensatho hnn of Calife nths."
<br />Signet! ..»........,..............:., ; .... s x .Owner �
<br />13y .... . .. .... ... .. ....... 3� itiaa .,. � e� � �'!s� ... ..........:.....:..........
<br />(if Other than owrteai `� �
<br />��1
<br />APPLICATION ACCEPTED BY
<br />BUILDING PERMIT ISSllirb _
<br />ADDITIONAL COMMENTS.._.., ......... .......,,..Y ...,....y.� �. N...�,...`.•..` ....»..., .. ...,........©......., .......,,........ ................
<br />.....:
<br />...... ............. .............. ........ ,............ ............... ......... ......_...,.... .,......,..... .............. I ..... ....u..,.... .......,...,.......,.................. -.,,..........
<br />.
<br />.MN, ...r,..
<br />.,.al inspection byx ,�..,......rV'�F .._,,. .,,...Y�......,......,...................
<br />............s.. Date .. /.....,.__...
<br />...' .
<br />EH
<br />13 21, 1-6#1 Rev.[ SAN JOAQUIN LOCAL HMTH DISTRICT' 3N
<br />x
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