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~ <br /> FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> -'--- NCwn��w�m�m �N��m��f <br /> Date Issued {>_�/_./�� / <br /> resYear From Date issued <br /> '' ! <br /> - _-__ . <br /> Application is hereby madeto the San Joaquin Local Hmm|fh District for o ' it to construct and install the work n�' <br /> = <br /> n <br /> described. This applicationcompliancewith County Ordinance No. 849 and existing Rules and Regulations. <br /> 1141 / <br />' Add ~����m�' —' ' �~,�Phq�e <br /> ' L|oanse v� �� �0. ---------'- <br /> Contractor's Name -^-- �'��-'-- <br /> InstallationvvN serve: Residence ^entHouue-E] ' merciulT]Tru||erCourt <br />' <br /> Motel, - <br /> Other --------------------------------------------- <br />| <br />| <br /> Number of living units: -/.—. Number of <br /> r «�'------Garbage Grinder ----- <br /> ------------------------------` pnvu,e �� <br />! VYomr Supply: Public System and name -' ----'��'—_'_'_------- --'-' <br />� (�����i|� o �� �3f� ��� �h� C|oy E] ��� �r� ��m � Ouy�m� � <br /> Hardpan E] A6o6e'F-I Fill Material ------------ |fyes,type --------------' / <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> � NEW INSTALLATION: (No septictank or seepogn pit permitt if public sewer is available within 200 feetJ <br /> ' <br /> PACKAGE TREATMENT [ ] SE�OCTANK~ �> Liquid Depth -.��------'-' C� <br /> ------' <br /> Capacity ���*�v��4� Typ� . .-. 8Amfeda| No. [ompo�mw�s`��z�m��."�� <br /> ' 1* � ^` V <br /> Distance to nearest; Well .---'� +��".,---_-Foondp�on -,^��---._'p,op Line _'''.���'-'-_ ` <br /> ' <br /> LEACHING UNE <br /> ^ No. of Li �? ' of each line---------40v--.�~-- Total Length <br /> -;P--------- <br /> JF ----------------------_- <br /> 'D' Box <br /> _----^F' ----'----'D' 8nx Type Rher | Depth Ghmr Material ------ <br /> Line <br /> — �nw '-.-----Di�oncen-eane�. Well ---u�=�--. Foundation -------------- Property <br /> / 6EEPAGEP|T Depth ���---�-- C�on�nter --'_- Number ---------------------------- Rock Filled Yes C] No �] <br /> ` ----------' �pc� �zm <br /> VVo�x Table Depth ._...�----_----^--. -------------------------------- <br /> Distance <br /> _._'-----'- � <br /> . <br /> Distoncetonoonao� VVeU -------------------------------------Fovn6p�on ---'--_ Prop. L�e --'-_'-_-- <br /> ` Date ) <br /> (Prev �on�o��n Perm�s� -'------'—'--- —'—'-----'--'-' <br /> � ^ <br /> ' --------- <br /> Septic Tank (Specify Requirements) ---- ----------------------------------------------------------------------- --..__-----.__---_.-'--_' <br /> [xsposo| Field 0pecify Requirements) <br /> /. _--_'__---__`'�-''�-'—.---'-_-.-�—~~~__ --_~-_-_-_—~-----~''~~-�' <br /> ----'—'---'—'--------------_---'_----------'-----'-''----------'- <br /> ------- <br /> ------------------------- <br /> _ =� . ----.-------_-------.----.-_._—_.--__'_— <br /> ._-_.—.---_—.—= —_�_ <br /> (Drovmximingon6 required ud6Qhnn on navemo ukde) , <br /> | hereby certify that 1 have prepared this application and 'that the work will be dome in accordance with Son Joaquin <br /> County Ordinances, State iavpo and Rules and ReguliatimnewV the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that | the � *, of the vv*r& for ,v6ichthis permit is issued, | m6aY| not employ any pas to become �rwwm U� mm�� manner <br /> subject to �� ton~1 <br /> -a'*s of California." <br /> If <br /> . � -'-�- <br /> ��� ��rw�xvmm�NY USE ONLY <br /> D�T�m- ^m-^� - <br /> APPL|[AT|ON ACCEPTED BY ----'---------'-----'--- -' - ---------' <br /> '� DATE <br /> 8U|LD|NG PERMIT ISSUED ---_-------------.----_-------'',--^---'- ----'----'---'-- <br /> < ADD|T|ONAL COMMENTS -----.-----'_-_--------._-------------'-------------'--------' <br /> �------------_----'�----------------------------------------------------------------------------- <br /> ---_������-------_����-----------------------------------------_-------- <br /> ---._--_'_--.---_'-'_---'--_---.--__'--- <br /> -.---_-- —. _-_--_ <br /> '---'__ —.. �� � �- <br /> .—'''---- <br /> --Dm�o ` �x'-�---'-- <br /> _ —_--�-'---------__- <br /> R"ol Inspection _'----'-----'—' ------- —'-' <br /> SAN ]OAQU|N LOCAL HEALTH DISTRICT <br /> E. H. 9 l''68 Rev. 5&4 <br />