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FM ofFICE USE, APPRICJITHM lR SAWFATION PO1MIkIT <br /> .................. ........... Icampl+be in Triplitebi Permit <br /> ....... .... .............---•- Date lseiud. :Via:7L <br /> .. 'E Penrdt irgdns 1 vow Ar Dsde homed <br /> �*pplic tion is hwoby made to the San Joaquin local Weald Dlstrld for a permit to M*L4;t and Install the Walt aNnin <br /> described. This application Is n+ade In oompi with County Ordinance No. $499 mW ousting Rules and R"uC� <br /> JOB � � TRACT . .....: ...... <br /> ....".�: <br /> . <br /> Owner's Name .. ................................................... ..:. ...,r........ftom ...4164?46-P.,'1......... <br /> Address ........ p/ .... .... a...� ��'... .il ..CHy ... ..... ...............-._.... <br /> Contractor's Name ..�.. �..T ia .................................................ktaeesAa .e , .. Phone I <br /> Installation will serWsidence Apnrhtrertt Haasefl rn <br /> Coner"❑Trailer Court 13- j_` •?79 <br /> oma <br /> Motelp OOW ............................................ ; - <br /> Number of living units,-..A-.... Number of brdroorne .-.3—Garbago Grinder ............ Ll*Shm . . .. ......... <br /> Water Supply: Public System and name ........................... ................... <br /> Charoder of sail to a depth of 3 feet: .rand 0 Sift Q Ckty Q Pow© Saadi/Loam Q CkW LOOM 9. <br /> Hordpawo Adobe JK FIV Material............If yes;............................ <br /> IPIot plan, showing size of lot, location of system► In ration to wells, buiidkw, etc. nwst be piaad en Few " dde.1 <br /> NOW WSTA"TION: INo septic tank or seepage pit pemnitted If pub14 lic sower is avaikMo w*M 2W feN,l <br /> PACKAGE TREATMENTE SUM TAMC jt ..Ma....,?. . ........... L 4uld Mp* ... .............. <br /> ty -�-��--�.P•.... Type at.-;17at.-;17. � W Mrld. c.._�. Na Cal parimenis ....�..j...... <br /> Distance to nearest, Well ..................Fouriakrtion ....1.0 'r...... Prop. f.Me .................... <br /> aAaim LINE No. of Lines,3................... length of each I1w..--... ........... TOMB twooh -...bio 2.'»......a <br /> 'D' Box ...1..__... Type Fiher Materiai��..Dopth Ft#ter MaNrlal .�..©.��............................... <br /> r . Foundation <br /> Di:tarnce to noarastc Well _�..—�_Q... .._..... .../..ur.............. Property Line .-....�R:Q..., <br /> SEEPAGE PIT De •� -. ''.... Dlatnetor 5.5V.-: <br /> pth .-_ , f+w*bw ..r"5. MW Yes No <br /> Water Table Depth ........_L ........ ..............Rock Sl=e `- M s! y <br /> Distance to nearest, WWI ....�..s` 'Q.�.�.r......_...Foundotion ..... 1 .�_. flop, line -... l l.... <br /> tliFAN/ADDITI4M 414w. Sanitation Pemrit Date ...�.....�......_....,....,...a <br /> Septic Tank ISpecify Requin"nentsl ....................-------- ........... .......... <br /> �...:.:..........r� <br /> Disposal Field ftedfy RequirerrAnW ------------------ .-------....-......................... ..................... <br /> .................... .............. ...............7------ -.._....._........................... ..,,:..................»......_..... . .. ------------------ ---- <br /> ........... ......................................_... ........ _. .. .........,......._... .>...........................__............................ <br /> IOraw existing aril rs4uirod addition on reverse sk�l <br /> I herby earft that 1 haw prepared this oppllealiers cad #hof deo week wN be deae in asseeawee tab SDs J=9dit <br /> County Ordlnomes, Stsh Laws, and Rules mW Rtepukdons of 6e Sm Joh Leal No@W%M#d.Meme w%VW ie now <br /> see!""ft sigeahrre wdifias the W wl": <br /> "I certify Heat in the perfaimm rrce of dye work far wMch We peasnb Is isswd, I sha no erupt!awy Pesten in SO&sNorrsier <br /> as to bwepe sebbW orkssw's of Csrlifwta." <br /> e n.. <br /> Signed -- --- •-----• ............—Owner <br /> (If other than owned � - . <br /> ARTNNiT USE ONLY <br /> APPLICATION ACCEPTED BY _ DATE //.,"1-�. <br /> BUILDING PERMIT ISSUED ........................... ........................._.... ......_........_......DATE .........................I........... <br /> •.... <br /> ADDITIONALCOMMENTS..................................................._...... ._..... ,......... ..6......... ....--................I..... ................... <br /> . . . •----•.._.. <br /> ......`........ ... .. . ......_.,.....- ............ - -......... ..--• - -- .._._.._�__..._._.�_.. ...... _.. ._. ................. 1............ <br /> ... . <br /> Fio nspedion by: .............. �.... .._ -_................................................... ------.......... Oafe sir ,Jf . <br /> $i 13 2a 1-68 Hew. JOAQUIN LOCAL HEALTH INSTRICT 3H <br />