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"MCZ USE: <br /> ..... ....... .... . .... � A 4I 4'`1C N FOR S�ANMATIOM PFRMtr � .. <br /> Mig A-♦mom.-..f..yh•w e..., �..G .. <br /> (Complete In Trlpncete) <br /> _................................ Qhla Parmlt Explres 4 Year from Dafo hsued <br /> ^Vµ+AcWIca0crA Is hereby made to the San Joaquin local Health District for a permit to cansnict and Install the VW& herein <br /> cr(xc.ribed. This application Is matte l,+e compliance with County Ordinance No. 540 and omisthq Rules and Regufatla m <br /> !O& ADDRESSAOCATION . .... G.0 ry ....r./.. . . `r��.Q�� �,..li,•� TRACT ................ ........ <br /> <°+rner't Name ..... . Pf10M ...........................�.^... <br /> Qty .f. ............................ <br /> f tar?rr]Etor'6 Name�y r � ..J� ..�5.. }.. 7�iorrlf�f .e.1•f I..�jt Pfta1N � y•s.tii.�i.s!5�1�� <br /> �noaliatian will serve, M"Wer"p/lpartmont"ouso0 Co mnercial Cpaller Court C) <br /> I <br /> iMael❑00W..:......................................... <br /> i Number of living unit .... .... Number ofrn';,z <br /> . .{iarbo,Re1 Qri ..: . lel sin .... ..,t'�.......... . .. <br /> Water Supply, Public System and name ..... .......ti'�eStL�.L..._.»..»..... »..........�.....».MVe/o <br /> Character of soil to a depth of 9 foetr Sand❑ Slit® Clay ❑ Prat Q Sandy Frozen❑ Cloy tam Q <br /> Hktrd� Adobe❑ gill Material............M yet.typN..»...»...... <br /> IN01 p!cli n, thawing size of lot, location of system,In relatlen to wells, buildlnps, one. ,noel be placed an rover" s&.1 <br /> I'MY INST'AU14T'IOM (No septile twit or "opa" pit,perm _if p,lle sower 1s evollable vAlhIn 2W 40,1 <br /> ( PACKAGE TREATMENT ( 1 SEPTIC TANK= 1 1-4x- / is........I.........».». Uquld Dsph <br /> Copadty .................... Type .................... Material...................... No. Campoirne to ....... Q <br /> ' Distance to newest, Well ....................................Reurdatian .............:......» Prep.tine»........�,.......a <br /> i� ,�#€tom LINE No. of titer :. ......., Lev* d 1 ......,... Toted tar,* .�.d�:..........0 <br /> 'D' Box ..: . Type Filter Material Lf ,! Depth Filter Material ./5!!''........... ...»»........., <br /> �. Distann to rrsorpst, %Wll Foundotlon ... ........... Property ulna ....ti1^ ............ <br /> SEEPAGE PIT Depth cJC.......... Diameter 22...... Number ......./........ .... Rech Filled Yoe No (3O <br /> Water Table Depth ........�rcfJ ......................Rock Stye .. .f............... / <br /> jDistance to near s+Will /0.E!............................Foundetton ..,1 .......... Pry, lMe ........ . <br /> WEPAIR/ADDIflON(Prov. Sanitation Pormitf.7X}� pX ...�5'. ...2.1- Dalt .................................. <br /> � <br /> Sepik Tonk (Specify Requirements) ...............G '$ .y.... ....l ... . . ............ <br /> Disposal Field ;Specify Requlremsntii � Ci., f .. "t . .. .rL ...............� <br /> ............ ..............................,................ ..r.'...... �rt........ ?.�1....................................................................- <br /> �. . ......,_. ... ... ....................... <br /> ............ ....... ......................................................... <br /> (Draw oxisting and raquired addition on reverse&idol <br /> I hm*hy rsttffy that I have prepared this epplicMian Bend that this work will be done M te-ah — vrfth !aa Jeagnifa <br /> Caunty Qrdlnaeces, Slate Lawn, a" Butte and Regulations of the Sen Je"uln level Health D1sMN.Hems sMrnor er ll004. <br /> red agents slgneturs CoMfles the folleRvlrgt <br /> "W enrtify that In the performance of the w+erli ler which this permit Is Issued, I shall net employ any pereee M such rnattner <br /> ' as tobiams subject to Workman's Compensation laws of California" CEARME'.S SErirC F snesR mr.1ICE <br /> S rd <br /> I-, <br /> ................. Owner �'l3 ` <br /> �gn .f. fh..iv:+•":L'y c �r:rac!���` !.•c '177 <br /> Ilf other than own�rl <br /> IID � us� o r • <br /> APPLICATION ACCEPTED B ,,�..... C... ...... DATE ........ ... <br /> BU IDINtt f+ERMIT ISSUED . ,.. . .DATE . . ... ..................I............. <br /> AD!)ITfONAt COMMENTS . ........I....".,...... /1111-...... ...... . .... . .. ... . <br /> ._.. .. ....... ................ ....... .......... ... <br /> ..... <br /> ..... .... . <br /> ................ ..... .................Date . ..''.: ; .. : . <br /> .,.... .. .. <br /> 1-69 5M SAN JOAo; N tOCAt MEAUM DISTRICT 8/711 3n <br />