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�• -FOR OFFICE Mi FOR OFFICE UM �
<br /> AFFUrATION FOR SANITATION FERMiT !
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<br /> (CArnr►l.to 1n TtIPIIC sI Permit NG:,:7r,d,. ...y'
<br /> ..,,..................,,.. .. .... ._... Date ixsaed.�—�f.. 7
<br /> .........._......._._._................ .............. flat Pernth expbw I Va.Fram Dot*hived l
<br /> App!1o0tlan is heretry mode to-:he Son Joaquin tocai Health bistriet far a permit to Cofttrw and Instill!the work harein described, 1
<br /> This application£s made in camplionce with County Ordinance No,S $and lxistitSQ Rules ar+d R ulariars,
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<br /> 1OB AbbRF.55/LOrCA 11"Jiwl—... .. . .. aRA[T._.................. '
<br /> O+nrner's tSartrtr,..., .. ....:................•--.....--Phorte....._........---._.:.....,
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<br /> -------- ...__.._City.,—............ ..j............... ..Zip...:.. . .....
<br /> Cimtrasaar's Nome..... a .. ..[•. _..Licenta�f. :B `1.�/ .__Phage: , l.: Tf ....
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<br /> Installation will serve: Resldenre I Apar"heni Rause C6msner"(:1 Trailer Court
<br /> rel ©' O Ilia,:.:... ,,.. `._-.._......:..._...,.. ,
<br /> Number of livtvp unlis:._,,. "'blumbor of bedroarnt_ 9. 4_.._Gorboge 116nrfer.......
<br /> __--lel Size.,... ...__,.....,-•.•.--......__
<br /> worer Supply:Public Sytiern and some—__.....................,-. ..-- Private '
<br /> Choratter of sail Ia a depth e(3 1eet: "rand❑ 511110 'Cloy C3 fico?Q Seady toorn❑ Clay toans E3
<br /> Hardpan L Adobe,d Fill Molvial .......If yes;type.......:.................
<br /> IT"10 Plan.showing s::o at lot,location of system in ralotion to walls,buildings,etc WnW be plated an revarse WC-11 }.3
<br /> _NEIN.MSTMEATION: INC soptic tank or seepage pit permilsed if public sewer is ovollatyle wit}„n 200 feet,l - }3
<br /> PACKAGE TREATMENT SEPTIC TANK...
<br /> I rSize. »...... .. .. ................:..._........,..k:r{�rid Depth. ., ^_ h,1
<br /> s way.. '.Type_.... _MWerioi:. ...........No_Canspartment.%..
<br /> Distance to neorasec lNeil,;........,.--•--__ ---.-------Foundaetlon.._.._-_.. ..._.,,.,:..Prop.Line_._.--..,.- ...
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<br /> LEACHING LIME J No.of Lines..::- ....:._tangth of each 111161," 10401 Length .................,.,... _.._._._.
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<br /> Q`8._- ....`.:T'ype Rifer Material.,,._...,..'._:Depth FIFrar Mdfeni01_--..---.-.._..,.�__..
<br /> fistcI ... ...
<br /> ncotonaftresri Well....................... F61Lrridal1en_..---_..-._2! Property Lina......-......._.
<br /> 9EPAGE ftr I ! Pth_
<br /> iatre t , Ye
<br /> ..,,0 ter.............. ..:Number....-•„•--••--.--•.-.-...:...:. Rock F"1lod s No
<br /> _ Water Toble Depth...................
<br /> ........... r....A..,_.-Rack Sixe...... ............................
<br /> &sronto to rserrrettt Well__ ..>,,..<., ._.---_._.,............Foundarlon................ ....,..prop;Line..,_.. ...,,_,. _A4
<br /> REPAIR/A9OITION[Prey Soullatia s Peimit 0.........................., •.._.. .....,......E7vTe.....,., , .,..- ................:. .•..►
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<br /> Septic rank ISpecify Req-uqiremonW........_ _._..,_.._.:_...:._., ............ .... _.,.,. ...
<br /> Orsposoi Fieltf l5pecilY�4 . .. . sl-.--.....-f
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<br /> Meow existing and required addition on reverse s4el
<br /> I hereby sMity?(tat I have Prepared Ws.applfcallan and that lb* vr*rk will 6e dome In ossordar* wits Sots Joaquin Csenly
<br /> 008ieeW016•statetsw
<br /> Ls and Rales' orA R*gAutiorrs of the San 9onquia tCaal Meafth Obbicr, lien+*owner at Ik*nsad agents
<br /> silratme oK""tlry fel kap,A91
<br /> "i Certify That In the pbrformeeC*6f the worst For whkk"tIs polmll is issued,I skill,sot ampby any Psrsae In such mow"t of
<br /> to bs cam* sub" to Waelsman s, CaoiiPa&*aak n hews of C difistado.-
<br /> Stgrrod. .. .....,., _...Owruv
<br /> [If'01 thon owewrl -
<br /> II AtmT us-1 ONLY _
<br /> APPLICATIONACCfPTEf]fSY _. ...,..,,,,•.. .................................DATE:3 -7•. ._.__. .._._.
<br /> DIVISION OF LAND NUM9ER..,....-—... .........
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<br /> flATE.,�..,,.,•. ....
<br /> AQQST?ONAL CAhhIYSEPIIS ...—...... ..... ................ �
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<br /> Sra�t tewr etV,...........
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<br /> ;na! Insp,en,onby:.._ J _ ......:. . ............Dme. ,. .,,.
<br /> M a7+ SAdkQU1N LOCAL FEAtTFQeSICT .
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