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FOR OFFICE USE /1, H S - - / <br /> .. APPLICAMN FOR SANITATKIN�.RINIT <br /> (Complete In Tripliaat&I Permit No. /;;!S- N <br /> This Patalt Exists" 1 Yew From Oat&141svW Data issued / .J.. <br /> — )f t_. V t -� <br /> Appl:c6hon .s he. mode to/he Son J -� -T/ <br /> &by otsquio local 1teolM Qi tries !oro in to const o install " work herein <br /> described This epp ' ,on :s uvpde.in lienee No. and zistin Ru rd Requ <br /> t, 1 <br /> JOB ADDRf55llOCATION fJ /S ri rZ,�/ `?C- � TRACT �E <br /> Owner's Nome R p6Ri L//!P�/! r� p4ij// <br /> Phone <br /> Add <br /> �P ,asx <br /> � ress - - <br /> Contractor s Nome A4'* /CAPA " license I PlraM OocdYw/4' <br /> Installation will save +'- <br /> Retideriee Q Apartment House 0 Commerciol OTroila Court <br /> M6te1 n other "/;Actor e�-l�.a.:.. <br /> Number of living units. Y Number of bedrooms 8 Gotb ` Q� �Lr• <br /> og& Grande►��- tot Siie <br /> Wafer Supply. Pubt.c <br /> Syssem and Home <br /> Chwacrer.ef-w t too depth of S feet! Sam 1D--5+M•0—w}oy-p---Pecrr --S loom y Cloy Learn a : <br /> !Hordpon LI Adobe C c Ftlf Mot&rr'$f H yej typo �• <br /> (Ply Plan. th~ng size of br~I anon of system in rolutionro wells, �ri1d�{wOs„'eK, "hist •plopd an reverse fide. <br /> / .. <br /> ' NEMI�OMA1lAT/0N: IN* schc�ptont be`seepage pit permirid N p�ublir sewer b_ .ovdlOble wirhirr200/tae,) ' <br /> PACKAGE TKATlAwr ,!• SEPT -'FMN p6�4/ Sise. X�X +fluid_Depth .-.. .. <br /> t ` <br /> �- -- - a .. Mait`erio 'Oe No.. tom <br /> ;r U'stance Ilk r+eorest Weil�,�i ',._. ..:..1.. fourdof�onw110 <br /> tEACMINGIINE [ ] Ne, of [ir�ey/y,(. /LCOr t&npih of .odt�ur» r�yr.�r TWol le O. ..._...._ <br /> LL itgrh S/ <br /> �t D Boc/(/P Type Filter Metaioll�y Oppth F+Ito Mwar l'IYwa <br /> / <br /> 'Distance to neareseW;rr fo +o{t %S / Pro ' <br /> _ t Well WrfY line /�' <br /> SEEPAGE PIT ( I Depth 1 D+ameter Nlllrnbr �� Rack Filled Yes ❑ 11& C <br /> Water ToWe Depth <br /> Distonc& to near&st� Weil ....Found Prop. line <br /> ITI _ ........._.r <br /> REPAIR/ADOON ProwSanitation Permit i` rOoN/ <br /> Septic Tank (Speofy Requirements) I <br /> ♦ <br /> Disposal Field ISpaly Requir&m&n1s1 <br /> o3-.!G`r,�l`//`,rSfs_... �, '� ;• <br /> .��10rdw rc,snnq ond_required add+tion.M.revetw side) <br /> hereby certify that 1 hors, pr&poo this eppikosien and that the week will be dove in accordance %risk Son Joagviw <br /> Cocmly Ordinencos, State Lows. end Ruh* and Requlottons of this San Joagvin tocol Health Distiri s. Home a+raor or lien <br /> sed ogerim signature certifies the foibwil"T <br /> "I certify shot in rM perf&awnomq of the work for which MRs j&nnit Is bsar&d, 1 shah Hat awr111 0 any peva+ im 4110th maws <br /> as to become subject to Workman's C&mp&nsetien laves of CalRferwia." <br /> Signed <br /> BY to ` - it to <br /> ✓///fit other Mon awn&+I <br /> EPARTA"NT USE ONLY + <br /> APPLICATION ACCEPTED BY "u") TE <br /> BUILDING <br /> •�j J,� . . <br /> BUILDING PERMIT ISSUED // DATE <br /> ♦DDRTIONAL COMMENTS _- _ <br /> Final Inspection by: r. i"!.0 ett,.� Data 1 % /.�...,..... <br /> ,6TiA1tJOAOUtN LOCAL MEALTH DtSTRRCT <br /> E. M•t7 241--68 Rev SM <br />