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LF <br /> �����U� APPLU� TKON FOR �N��ON P �rm(tNo`|mm,�n ��;����)-��� p�mm��--- ' �7~ Do� |sso�6 .-�..�I����`�—�� Frmm D I atmIsowed <br /> � ���r� /nm-- �/ *» mrm� in�oU tha vvork he,an <br /> i o6 to the 5 nJmoquin Local Heo|�hoi��c+ �n o c»» imN o""o|es and �*guk�\unx <br /> App)�o�m` » |� nnud��n c^mo|\o�c� vvKh C�unry ��6inonce No. �4v and ex ng�n <br /> described. This application "i-r of king units:-/--------- N'umber of bedrooms i" ------Gq`rbdg6 Grin A19 Lot z <br /> . ' `_ <br /> Contractor's Name -f <br /> Installation Will serve- <br /> ----------------------- <br />. umPrivate e <br /> be <br /> t. SandO Silt Clip peat 0 Sandy Loam <br /> soil to a depth of 3 fee <br />` - - --------- '4~ <br /> (Plot plan, showing size of lot, location of system in rellati n To/wells,'�buildin' must be placed on reverse side.)| ars., etc <br /> " eris available within 200 feetj <br />!� ----------0�T���� ��` �n» ;p '^�'""~ "' ^~`.�-�- ,' - it 'NEV ----------- Liquid Dep <br /> th ---'------' <br /> CTANK{ �/�� . --.^ <br /> S��Ompo�men/ --__-'--- <br /> / <br /> ' \N�\ <br /> Co� « �°-"" <br /> CopochyI ---- <br /> ----------------- <br /> Type , ' - Prop <br /> . Une ' -� ' ' <br /> isVe | �- Foundation <br /> -Total Length~. __—.-�en�rn <br /> h line <br /> LEACHINGUNE ; n of Lines ----- ^ | I <br /> Depth Filter <br /> D' Box J--------- Type Filter Material <br /> ` .—�. <br /> Property��ono /o ------------ <br /> -11Di�once '" neona�. VoU '�._.----- F`o | Rock F��d_`Y <br /> mm [] No 0 <br /> Diameter ' Number � <br /> SEEPAGE PODepth ''' '' <br /> Voter To6|w Depth ---'-_-._'_----,_'=-- <br /> , ^ <br /> y~ <br /> -Rock Size ---'- - -- <br /> + <br /> � _,—�------�''/ . ._.---'--_ <br /> n -- <br /> � <br /> Prop. Line <br /> , <br /> ^ r--F�vn6oho <br /> Distance *o neo,*o� V *.| <br /> �o+e '-\`--'-> <br /> ~E, (Prev. # [` <br /> . ^ <br /> ' <br /> SepticRe <br /> . ".,'~^.. Field .','cif' . <br /> . " <br /> OF---15-0 x/ <br /> - - 'that ithe work ��� nimn San Joaquin. <br /> certify that I have prepared,,this application and <br /> ct. Horne owner or licen- <br /> land Regulations of the,San Joaquin Local Health istri <br /> ! County Ordinances, State11 <br /> sed agents signature certifi4i the following: h manner <br /> "I certify that in the performance of the woikfor which this perifflf is issued, I shall not emploly any person in suc <br /> as to bTe led t, ]a 3 -, - Owner <br /> porkman's <br /> ~ - <br /> Signe . <br /> � ------------------ -------------- <br /> --_-'`'_ <br /> �y . <br /> (If other than�owner) <br /> ------------------ <br /> APPLICATION ACCEPTED BY ...t�DATE�� <br /> ' <br /> FOR DEPARTMENT USE ONLY <br /> BUILDING-PERMIT-ISSUED-- <br /> -_� <br /> - -----_.. <br /> --- —_---._-_-Date --^ =�.,'--- <br /> �mo| |nspecM <br /> -�--~� <br /> SAN JOA(�U|N LOCAL HEALTH DISTRICT' <br /> ' <br /> | E. H. 9 l''68Rev. 5W\ <br />