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<br /> FCR OrOICE USE: .�
<br /> +' APPLICATION FOR SANITATIOt'J PERMIT
<br /> (Complete in Triplicate) Permit No.
<br /> r This PermitExpires I 'f ear from Dale lssuad Date Issued
<br /> Application is hereby madero the San doaqui—,Iran Heath Dishict (or a oermit to construct and install the work herein
<br /> described. This application is made in comelinn[e with County Crdinrncr; No 549 end existing Rules and P.egufations:
<br /> JOB ADDRESS/LOCATION ,/ J/�y' � :;� ; �; _ ,{ �1 C
<br /> :CENSUS TRACT ._ '.7.. ._..
<br /> Owner's Name �i'� ,.��� j/f/.11 �// i'r�
<br /> Address /i J� / v - .. _ Phone
<br /> Cit
<br /> Contractor', t! -- ! I.. ....
<br /> rme 'ir'/.-, . ✓ f^ ., ..r%�,_ '
<br /> Phone
<br /> mstaliation wit+ terve: Phone r Apur!ment House[j Commercial I]Trailur court
<br /> Mote!F1 ether
<br /> Number of living units: Nurl cr bedroo Tis �. .Gorbo e Grinder
<br /> g lot size
<br /> Wafer$unPIY: Public System and Horne) - - -'
<br /> - " Private 1�!
<br /> Chorocter of soil to a depth of 3 [ea., Son[IT'-'t Silt I__� Clo.
<br /> , Y ❑ Peat 1-] ;randy loam ""1 Clay loam n
<br /> linrdran t`: Adobo 1"1 F,J Maleriol If yc;, type
<br /> ;Plot plan, showina si, of lot, location eF ;,stow, in relation to wells, 'ouild ir.q:., etc must he placed on reverse side.)
<br /> MEW INSTALLATION: :No septic lank tri ;cr�page plt permitted it public ;ewer it ,.i a'Ichle within 20C (eet,I
<br /> PACKAGE ' I SEPTIC 7Ahl It j i Size _._ ..
<br /> liquid Depth V
<br /> L' Copia+y Type Material No, Compo.+mep : V
<br /> il";lancc ton
<br /> Wnll roucrintior Prop. Lone
<br /> _.. . _
<br /> LEACH LIN[ No, of Lines Length of c !,o, Tnia! Length L _.... .
<br /> D' Box Tvf•c F,Jcr Mtooriai ^eplh Fill r .'.1c;tcrial RRR�
<br /> Drtlnm
<br /> nce to .a.ash Well Found ion Property Line
<br /> SEEPAGE PIT j Deptli Diameter Numbc- Rock filled Yes [j No
<br /> + d-r fall , 'J plh R0 1 S.
<br /> U luno. 'o n, rJ•I ;Voll F ••::nri� Prop. Llne.
<br /> REPAIR/ADDITION"rev S rn' coon r t iF n1 I
<br /> Septic T,,n',. iS, I, r nr. :
<br /> U
<br /> I hereby ce 1 ly rnal I hove n•,pare I 1h;, ,,n I; a cn rand li thI. w t be e.•, nccorrante with San Joaquin V
<br /> Coe:ly Ordrnarce. Sl.l> Laws, and Ralr-. a:vJ Pegulallons of the San Jooa,cin lee.;; `L: h ni•Iri[I. Borne owner or licen-
<br /> sed agerls •.i9narwe rorri!ie, the follow;,,,:
<br /> "I certify I1101 in the of Ihc• v:orF for I.dr !his peruril i, i�•vvd, I sF:rl,' an
<br /> y pilon in ;u<h manner
<br /> os !n becart+c subjccr to Work—nn,; Campcn•arloa �nw•. .,f Cu L!o•ni,r '
<br /> %6V
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