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' FAX 209 838 1345 MIGUEL PALOMINO P02
<br /> . R a l p USE, /JAMCATION FOR SANITA;ION PEM101
<br /> {Complete In Triplicatel
<br /> ._.._......----........_-_._,__.
<br /> Date Issrrerf _.. ...
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<br /> 'Mils Pftatllt>wrrpir*r t Y From[tcrtt#rsysd
<br /> FILApplication is horeby made to the Son Seacguln Local I•Iealth D- met for o permit to cors i I+sr+sle
<br /> described. This application is roode in complicrice with/County Ordinance NO. 544 and existing Rules and Roqulutions:
<br /> JOB ADIyRf.S$/LC+CAtIOM r ._C_, C '3w .P� . .----CENSM TRACT --,.._ ......
<br /> Owner's Name _ . _, .. ..r..._. �. . ........ :..•'::..,, .... _...-_.�• -- -.P rte
<br /> Address . . ........... -. ----- ,; .................... .. . .city .:-- ._..,..._.__--.
<br /> Carrtraetar's Wawa . .........,..... . .......,... , ...... ....,Lkvrtse# .................. - Photic
<br /> 1 installation will Lame.- ResidariaapAp6lr wet Naww'p Commercial OTralrer Court 0
<br />° Motel El Other- - ---e:--------1--l—..........
<br /> Number of living uriitst �.... Number of bedrooms .. ___--Garbage cmirwler .............. .... ..--
<br /> Walar Supply: Public System and name ....................... . ....•--• --------.._.. � ........ Private❑
<br /> Charartr,r of sail to a depth of 3 feet- Sand 0 Silt Clay C] Sondy t_oatn� clay Wam CK
<br /> Hutdpan Adobe❑ Fill Mir
<br /> (Plot pion, showlM Prize of lot, location of system in relation to wells. but4ings, ars. � placed onreverse ride.(
<br /> NEW IWAt1.ATWAO: (No septic tank or wepage pit p tocol if public �i�`wttllir►200 feeta „� 1
<br /> 1,
<br /> pACKAGI=TREATMENT f } SEPTIC TAN — .. _� ..... y L uid Depth -1—-------..,,,..
<br /> ECaprad _'TyPX ------ -. .. hAatefial..., T'I_...._... o. Compartments ..-;P,—......_
<br /> Distance to nearest: Wel{ ........-.............Foundation.... _-r----Prop,Una . -------
<br /> LFACHINO LINE [ No. of Lines _.._.. - ..... Len#h Of Wfr ilr e �` T t L�tgtls � ------------
<br />. `D' Sox . ..�--- Zype Filter Mdtertal ,f� � �F
<br /> Distance to reearesf: Well .,...� ...............-
<br />` Papth ,1' .-...,. Dia Ra__cit�Filled Yee No ]
<br /> }'
<br /> wow Table Depth . e.. ......................Rode 5#se .,f!'rte.w. ,, ..
<br /> r Dislomm to nearest Well ................... Prop. Line ..................
<br /> ISPAIR/ADDITIl'N(Prev. 5anitation Permit _........................ . ......._-- Datta ..............................-1
<br /> SepticTank (Specify Requirements) .-._..... ...... ,_..----.......................................... .. ... ......-..._........_._ _......------.--..................
<br /> Disposal Field (Sindfy Requrfw titnts) .......----------...... ....... ................. -- -............. ..... ............... ... - -
<br /> ..,.., ...._,.,., ....---- ......•----•--•...............•----------•---• ........._...................,.... .._....__ -,.,......------------- i
<br /> . .--- . ... ... ........ .... ................_. .. ............--•---- - ..............._...---------------------------.._..._..........._-••----•----- .•. •----•.
<br /> 10raw eaistingl and requ"cl addition an reww side]
<br /> II hereby certify that I have prepared this application and that the work will be dww in accordance with sam "An 1
<br /> County ordinanxes, State Laws, and hulas and ltlgsslatlons of tits Sort Joaquin Codd Kserhh b1stdct.Kome .renter er lkwo.
<br /> sed ag entr$Nnwtwre h Willes►the f allowletgs
<br /> "I sar#tty that In Ito* perfamtance of rho work tar which this Vest It is hound, t stroll fret employ ow person in each frsanaw
<br /> as#e bm*me subject to Workman`s compares e"n taws of Callfornla
<br /> Signed .... .... .... .........._.._,-v...... ......._ ------8y {I Cf, cam? . . ................. ltle k ....Ct * .....
<br /> f a er tffan owned -- .........
<br /> [ ARI 11117 USE Clay
<br /> APPLICAT:ON ACCEPTED BY ----..... ....I.......
<br /> ....
<br /> WILDINGPERMIT ISSUED ......................,,,....,..,.--------------_..._._.......... .............----------------------DATE .,,.._...._ ----I--------•--......
<br /> ADDIVONAL Cr3dV4MWS
<br /> Or
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<br /> Final lnrpactioM,bYr_ ........... - _ ...
<br /> SAN JOAQUIN LOCI HEALTH DISTROCT
<br /> ., 1-4 'JELM ,.^ f4._. e.i 7/72 3 K
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