|
a.
<br /> i
<br /> I
<br /> WY.6,r'''
<br /> FOR OFFICENil
<br /> ���3 ' L y -1 PUCAT11O FOR sAHiranoN`PCS,
<br /> !
<br /> atio
<br /> Appgcation rs hereby made to the San*Joa§uTnrl ocal Heatth Distnrffaram,►�o �onsia11 f t o ' hereir
<br /> descrtb'ed Thrs'appircat�on{rskmade�'ln�complfprice witft�County'Ordinance` No"t""549�a`ncl�existln�Rule`s and Rey�ilo#ons.
<br /> B ;4bDRES ����t°� -� ,� ���r��� ����t'�kp^' ;.Ar �•-'•-
<br /> S%LOCATION ,p.,�Qa ;�xt Vie^ �� �` ` "
<br /> CENS S TRAC
<br /> Owner's Ndme� ��QJ7d�s/� /�c77i�� a �r �t..w ,
<br /> Y .f_ one
<br /> � {149 � x s"ri Cit
<br /> sJ' �r''V'ate, ` `4rf5#`�t i d°`z 3•}r i S'� ; A i... �' wu a 1 "771
<br /> Contractors Nam t �,Ji t� r �License# ` / Phone
<br /> Q ��p{ L. �
<br /> _ s�- sS ,S. D=�:,f, C7 - .,Z• a. €: - n1 .":.. 'gitf' � (iR''
<br /> Instal bt on wtlf serve �3 !, esidence[J Apartment:douse fl Cammertlaf❑Traflar Court']
<br /> �, Cr R 1 y+3p�y� MO et41 A >t Me;
<br /> Numberof l�rwn rNum
<br /> s �t »�"''�..•+��,�,� '� k ���;�,��.� A
<br /> 9
<br /> .,.Un Its. '� ,Number�of bedreomi ... . � wdrEs ge,Grinder ��'.° ofMY
<br /> Stxe'
<br /> ♦ J D ' � }rs r4��� ��7fr..s{(,,,tiy
<br /> a er==Supply P� i,c System gridSname #^; , ? r, a .
<br /> vow + f1� mr> ? ...
<br /> C aracter of,sotl toga depth of::3 fee# 5ai S11t❑� Clay? x 'Peat❑ Sandy Laain l]f C d�j l'oa�n '�
<br /> Hardpan Adobe
<br /> Fill
<br /> Aiateno! If,yes;; peg
<br /> �3.
<br /> °na"�°, - - Or-IN S'�4. "S✓' yw• wre r.4xYa +aw, r r uma w.: t=1 d
<br /> Plot p ars, s awing size of�iota,�locatioei�of"sy"stemma in$'relation o wells„buildings ,etcs3must,ba paced ohs aVerse"a„s,_
<br /> .. "' ';'� !dL°pt
<br /> NEW,INSTALLATiON No septic tankor seepage pit perm€Med rf public sewer rs va ailbb a w1t [rr���4'c df]""
<br /> ,�., - . . ,,,... t
<br /> PACICAGE�TRATME T } ) SEl'TICbTANK[ } 5rZvi
<br /> iq r'd Dep
<br /> �Gl) Capaclty � � TYpeiY�[ 3°� Material s �� No� Compartm nt. "
<br /> DJstancP ,to�neares'�tWell �; � �"�� Foundarrort'�'� � Prop. si
<br /> CEi4CH ING`yl!�lf' (,) ` No oflCines� SLergthrof'eachtine�ti � '. dt. Le g
<br /> w�f
<br /> Type Filter Matenai�' � Depth41 Motor[A s
<br /> DIistance,to�nearestWell t` � t ,,Foundation Property lme .
<br /> "fid 7�. ! ,� -„F`Y°RFa.4k 1,$6W'� / �i stq,y •.y;r•k w .t� i-
<br /> SEEPAGi IDe th piameter r�� r..
<br /> �I�tumber �` � � Rock F[lad Yoe
<br /> .<sa;S@fdc'��; 'kDr'
<br /> Water Tab1e.NDepth 6' a ix A ” ROGk�S[ze o+Z ,
<br /> i Distance to nearest Well,'. z sF�Q�; h' Foundationk Q Pro l no
<br /> REPAIR ADDITIQN`Prevrr + kY "�
<br /> { Sbnrtahon Permit# pate k -}
<br /> . -.
<br /> Sept,c Tankq{Specify Requrrementsl 4y !� 4 tt�'�"�: tia r wp U
<br /> D �F�'reldc{5peufy,,Requrrcmentsl � .( ,/�.���. ! wd�.S.3 ..
<br /> r..'.
<br /> ittn " �t�' e� `....
<br /> {Drawexistln9 an lrequire d addit;on omireverse side} i
<br /> I :he�raby Eert[fy that�!�,have prepared thwappl[cation and Anat tthe work`ywr"If be done in accordance wil Sdn Joaquin
<br /> Countyfprdmances r,State.•'Laws and Rules and Re uialions a the,San Jos urn Local Health Dlsl►ii'f:Herne own or II e1i
<br /> �:r uw�xa 4 �. g a , �Q � �... .,.,
<br /> s agents signature ceMfies the foliowing:t �r �
<br /> (`certify that in rhe performaii it iii orkjoii kh'this permit is lssued`! shall not employ any,persenlln such monger
<br /> cs, oyybacomei g6(ect t 'Workman' Compensation laws oF,Caltfornla`
<br /> °TaJ.I J 4
<br /> Signed � f•� �� oyc::�c � f r T „� ,: ,� r. `.`.�
<br /> t ,��:�� :�Ld �t`4kµd� - Jf ��'S ;�t'�.,'3 s r•r�`�, 1:}x r � �Ss
<br /> tllf'Ot>terthanOwner� rk�; } W",
<br /> a t �
<br /> '3E S,YIE{s �"a � _ ..
<br /> _ >, ra ass `;R• FCrR 6EPARTMEtrlT USEONLY t 51
<br /> AP.PI(CATIONACCEPTED 6Y r %' �-( DATE r� r
<br /> x
<br /> ADDITION PERMIT';t55UED c �r + - � ° DATE
<br /> MM
<br /> 6UILDING
<br /> ALCO �NTSt * s k fs�; ei@ sr tar
<br /> i.k .. .
<br /> r3 �
<br /> { f r�
<br /> ti Frnol inspection by � �!)' ��� .� to
<br /> SAN" OUlN LOC l HEALTH':DISTRIC'
<br /> T r � { g rxl-f
<br /> �r
<br /> E H 9 � , IV 68 Rev
<br /> III
<br />
|