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' <br /> , <br /> FOR OFFICE USE: FOR OFFICE`_OSE: <br /> APPLICATION FOR SANITATION <br /> (Complete in Triplicate) 10 E 7 <br /> iate-Issued.-.15��1.7-.1--- <br /> ' . This Permit Expires 1 Year From Date Issued <br />' <br /> Application is hereby mode tothe Son Joaquin Local Health District for o permit toconstruct and inmo|| the work herein described. ' <br /> This application is mo6m in compliance with County Ordinance No. 549 and oxioting'Ru|euon6 Regulations: ) <br /> � � �'�� �� -`� <br /> JOB ADDRESS/LOCAT|OV�-�/��� x � � Z^ ������� L�^r� . [ENSUSTkA[T <br /> -------� --���--� v^--'' ----' -' ----------' <br /> [xwno,'» Name... <br /> ome- ~_w '. _ C7'�x^u� --_------��- - � --�----'[-l�-y--���� '. -'� 'o—no'� 7 <br /> '- <br /> - - <br /> Addreso- � /3 -Zip... -8-- <br /> -. <br /> �. <br /> Contractor'sNome � --zip---- <br /> w, ---------------------- - nn.......`-------- <br /> |nstu|kzUon <br /> will oervn. ResidencertmentHouse 0 Commercial E) Trailer Court [] <br /> Motel F-1 [},her.............................................. <br /> Number ofliving units;------/-------Number of bedrooms ~� Garbage Grin6*, Y65-S Lot Size -.........��� <br /> --------- <br /> WaterSupp|y. Public System and name.. ------_------ - ---------------- --- ---- -------------P,ivote <br /> Character of soil to depth of 6aot. Sand Ej Silt [] []oy Peat 0 Sandy Loomo [|oy Loam [] <br /> ' <br /> Hardpan [] Adobe [� Fill Material ....If yes, type----------' � <br /> (pbt u|on, showing size of lot, location of system in relation to vvaUs, 6vi|6ingo' etc. must be.p]oce6 on ns/e,oe side.) ~~ <br /> NEW INSTALLATION. (No septic tank o/ seepage pit it permitte6 if public sewer is available within 200 feet,) <br /> ` <br /> _ � �J | <br /> PACKAGE TREATMENT ( ] SEPTIC TANK y�« �~ 8iza�"��~�-�^�~w �_-^---------- ��iiqvi6 Dopv��i.. ' -'K---` | <br /> �_--__---- �y ^ <br /> copo� x�/ <br /> ,y�� 00.6_�)4_Type.IM94MI37 | ar44AJM. N Co <br /> ' �-�' <br /> Dimnocetuneore�. VwL- _ ---- Fovn6ohon-' -- 'Pnop. Linm. <br /> -�-�' <br /> ' <br /> ' <br /> LEACHING UNE No. of Uno, - - -Leng�h of eoch Un �� � -.Total Length <br /> --------- <br /> { <br /> 'D' 8ux---Type Filter Material -'--Depth Fitter Material '---------.--------- <br /> / � ^�^�� <br /> Qimoncetuneorem` VVeL- ---'Foun6o�on--.���-----.P,ope,ry Une-..p�e�-------- <br /> | <br /> SEEPAGE PIT [ ] Depth................Diameter-------------- ......Number---------------------------- --- Rock Filled Yes E] No [] ' <br /> Water Table Depth--------------------------------------- ..............Rock Size................. -- ..................... ' <br /> � <br /> Distance to nearest: VVeL---------'---.�Founduhon-�� ------'Prop. Une---------� ! <br /> � | <br /> REPAIR/ADDITION {Prev. Sanitation Permit#L- --------- ----- ____- -- --------Date.............. ------------------_ ...... | <br /> � <br /> Septic Tank (Specify Requinumants)--- .... ...... --------------------- ---- -- ---------- - ......... - --'----- ----- ' <br /> Dispomz| Field tSpecifv'Ruquiremnnm)----..�-------------------- -------------- � <br /> . / <br /> ... .......... -------------- --------------------- ....... -------------'............................ ----------------------------------------- .........' --'------'----' ! <br /> � <br /> / <br /> -'— ........... ..............____------------ ---------------------------------------------------- ----------------------------------------- -------------......... ........ <br /> , <br /> (D,ovvexisting and required addition on reverse side) <br /> | hereby certify that have prepared this application and that the work will be done in accordance with Son Joaquin County � <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local He*|th District. Home owner or licensed agents i <br /> signature certifies the following: <br /> ^| certify that in the performance of the work for which this permit is issued, | mhmU not employ any person /n such manner as | <br /> to become w Compensation laws of California." �l <br /> Signed- .�,1�' ---- --Owvnev ' <br /> Wy........... ................ ... ................................. ..--------------------------------' Title-- ^` <br /> (|f other than owner) � <br /> � <br /> FOR DEPARTMENT <br /> USE ONLY � <br /> | <br /> APPLICATION ACCEPTED -----------' ` E '��-��'���� �- ------- <br /> Q|V1SV3N OF LAND NUMBER.----' ..... ......-........ ...........0 ........ .... ............. ----------------- ...... DATE....... ----.......... - .......... � <br /> ADDITIONALCOMMENTS....... ------- --------------------------------------------------------------- -------------____--------------------------------------- ---' ---� <br /> ` <br /> �............ ................. ------------ ... ...'������������ ------------------ .................... --'-------- .... ..... ........ .... <br /> ----'^------- --------'----------------------^------ ------------- <br /> ---------------- <br /> - <br /> --_------.- ' --------------------~_ ---��� - ---- <br /> ------'' . -------------- � <br /> Final Inspection 6v`-----���/�-_ --------'-----------.Do�e ..--- -- <br /> E« n »^ - S���JOA/�U|N LOCAL HEALTH DISTRICT manmv REV. /�^nm <br />