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` FOR OFFICE USE: <br /> ..... . ... .... . . ......... ........ . APPLICATION FO.... SANITATlON PERMIT <br /> . ............................................. (ComleIn r. p Triplicate) Permit No,'...7�- i�-6 t/ <br /> .......... <br /> This Permit ExpesYear From Date Issued <br /> - - ir 'T y bate Issued <br /> Application <br /> bed. lhishereb madeion it the Smadeon aquin Local Health �' <br /> �AtriCt for a permit to construct and install the work herein <br /> compliance with Coun��i.40rdinanc Na. 549 and existing Rules and Regulations <br /> JOB ADDRESS/LOCATION . !`� r �,,� <br /> Owner' ..� ,�i'�.......�'f c .l..C�� '`��1'. <br /> s Name .... � •...._,....._ .... � -... ... <br /> ... <br /> t. ' <br /> u�.G .. <br /> Address -� -:��- - - - ............ .... � .. ............ ....._ <br /> TRA <br /> I <br /> at�" �J city e . ... ......... .. <br /> • <br /> ._.. Phan .� �.T.9��..... <br /> Co trac�or's Name . _ ..__.._ .........--- - <br /> �` <br /> Phon_...... A7.,�O. .. <br /> license . <br /> Ins Ilatron will serve:. .. ,�.rj/ ..f.. O <br /> Residence Apartment House " <••-- <br /> t , <br /> '❑ Commercial ❑TroilerCourt <br /> Motel0 Other <br /> e of {iv;ng unit <br /> ....- - IVum�e`r-oi� . .�b <br /> rooms --_�-.. <br /> ay__.,.._ 1. <br /> Wo er S <br /> or age GrincierAT : _ <br /> pplY' P c System and n - <br /> t �`� ame .... _ t size <br /> Character of - : ; .. .... � ............... .... <br /> SI p h of 3 feet: Sand <br /> _.....- <br /> ❑ SLS Q,..- lay�npat t ` `'� �"" ,�, Private ❑ <br /> Hardpan Adobe ! Fil � J rdy� m p - Clay Loam ❑ <br /> tMa-fir <br /> (Plotof n, sh i r i j- _ fl��s►type <br /> PI ow -• •�-�.:,w.-w..=:- _._.. � °�__��.�•....�� •ti�� p ...... .. . ................ <br /> g s e of Iot, location of system relation to buildingS,_.etc. m� �� <br /> NEW IN TALLATIO No r must- I septic tank or ee a e `r =" be placed an, reverse gide.} <br /> PA KACyE TREAT 'EN p g o permittedi if public sewer is available within 200 feet,) <br /> [ ] SEPTIC TANK ; _ i i <br /> L <br /> P E y�o oa-,Q.. T e. - -L q Bepthl.................. i <br /> Yp /�-�C Materltti`..(!::: c.c No% Compartments .�,- -x <br /> Distance to�neare e}l <br /> LEA�HI G LENE r ....---.Foundation <br /> No.• Lis .. .... Prop. Line .�_ Y <br /> Length of each line �Q <br /> 'D�Bok- Tat0-Length ,/OO' ar <br /> Type Filter Materia! �,,j - <br /> --.._Deptlf Filter Ma rial -r, r <br /> fancelt{b nearest: Well ... .--•-.-�. <br /> SEE AG PIT Foundation 1� . <br /> Depth .5� _..._ Di -� ..::,:, ;,�hoperty kine y ' , <br /> ame er�,�. . / ........ -.. <br /> NumberWater Table Depth. � _... Rqc <br /> c <br /> viled ye <br /> s)5 <br /> o <br /> .................................Rock 'ze <br /> • .E <br /> 0 <br /> •, � (Specify <br /> : aran ermit�#: .... <br /> :,.WellL Distance to nearest <br /> REP DDITION(`ey- n •..._.......Founds 'on' ..,•.•....,.. Pioline �- <br /> rY; <br /> : <br /> ........ . ...... ...... .....:.. Date . <br /> pticTank IS ecif Requirementsl . ..... ; ; <br /> ` <br /> D spa al Field (Specify , ts) ............. ................ <br /> ----- .....-.. f- GSC:- ... <br /> ................. i <br /> -.......................•..._._..._...................- .....--_..... <br /> F ifig-and required-ndditidtt"an arse sem) f } <br /> € he eby certify that lrhave prepared this application and that the work will be done in accordance County rdinances, State taws, and Rules and Regulations of the San Joaquin Local Health <br /> sed ge is signature certifies the following: cordance wills San Joaquin <br /> "l <br /> C. rtif�that in the performance of the work for whichDistrict• Home owner of licca- f <br /> Sign d - this permit Is issued, l shad not employ ars <br /> - pe <br /> as t be ame subject,to Vilorkman s Compeiiration lowi o <br /> g i Californld:' -- - _._..._-.._____.. .------- _- non in such m <br /> T } �{ r• p Y Y Pe annex <br /> ..... <br /> ....... ..... <br /> Ill otherthan owner) Title <br /> C <br /> FOR DEPARTMENT USE ONLY <br /> ARP ICATION ACCEPTED <br /> BUILDING PERMIT ISSUED . .-... .._... DATE .� <br /> ADDiTfONAL COMMENTS ...- ..:..:.......... ................... .. . ... ...._........... <br /> DATE <br /> ........................................ • ............---- ... . .. - ..... '.. ." <br /> ....... <br /> Final ins G......; ................... <br /> ._..... <br /> ,.r <br /> QYIN LOCAL HEALTH DISTRICT ........... <br /> 1:3 24 . <br />