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� <br /> \ <br /> FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> Permit Na .���j���^- � <br /> (Complete lnTriplicate) <br /> . <br /> Date Issued <br /> This iExpires I Year From Date Issued <br /> Application is hereby madetothe San Joaquin Local Health District for o permit to construct and install the work herein <br /> described. This application ismode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' �' � CENSUS TRACT ---..-----' <br /> Phone---------------------------------------------- <br /> -----------''--- <br /> '-------'-------'-' <br /> Phone __'--_'_'--_ <br /> —License <br /> [wn�o�or's Name -- <br /> ~ [onx� <br /> H ' ao|o|�]?,oi|e,�uu� <br /> Installation will serve: R�o6ence@�V\po,mnent �usaFJ , <br /> Motel []Other <br /> � .-_=--_---x'.-----'-- <br /> Non6or of living units —. -- Number bedrooms -q-�/Go6zgeGr|n6er --- Lot Size <br /> Votar Supply, Public System and nona -____--_.----'--'--`-_-- ----'_---- // _--Private <br /> �rx�u� <br /> 4/ <br /> / <br /> ` <br /> Character of soil toodepth of 3feet.. Sand'El Silt[I , Clay 0 peat El Sandy Loam Clay Loamo. <br /> Hardpan [] Adobe F1 RU Material ----' Ryes,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 septic tank or seepage pit permitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMENT 11 SEPTICTANK14/ <V , " <br /> * <br /> �~~r~^ ', --- '' ' ' - , <br /> '���-_---pn�p L��F�undmMon <br /> Distance to neoeVe|i ' ' <br /> � J/------ <br /> of each line �m �--' Total � ------------ <br /> LEACHING <br /> -/---_. <br /> L64CH�G LINE No. of Um� �_ _ A, ' <br /> � <br /> / <br />� <br /> Material� ��o�� R��r N ,�n|ol .- ---'-- -----------_---------- <br /> V <br /> ' - <br /> -.,---- <br /> r Box - / Type J# <br /> ' � ^ Found �/�' Line. �4 <br />` Distance- - ' st Well � ~-- - - ` <br /> _[ ------------------------------------------ <br /> �--'- ---�--'_--- r�, <br /> .~ �R�ck RUwd Yes [] <br /> SEEPAGE PIT Depth -------------------- Diameter _-�___' Number <br /> Vo*a To6|� Depth -'��----__-_''�_'-_^---�ock Size ----------------------------- <br /> - <br /> -.-.-_---__ <br /> - ~, ' Lne ---'-_�--'�shxnce � o'e�` Wel ' �� --------Foon6oHun --'-_--' pn . <br />|� <br /> ------------------- <br /> REPAIR/ADDITION <br /> (Prev. Sanitation.Permit --------------------------------------------- Oote ' <br /> n�) ---�---'---.--__' ' ^ -�--__/--_-',--- <br /> '�'--�Sep�c Tonk(Spedfy Requ\reme �-_-_-_-'--'- . <br /> ' ' �i_ '-���-�--'-�------'---- <br /> Dixpuoo| He|6 (Specify Requirements] --_--_'-'---_-'-----'-------. '--'_--'-- <br /> [ ' --�--'-_---'''----'-�--'---------''--'------'----- <br /> , �---_'��_------_'_-__'---.-'�--+'-----_'_-�-_' <br /> ` / ---_--__-- <br /> . / _ _---_------__---_- -___----- <br /> � ---------'---�-------'-�--}ro mhngon��eqohe6'add i tk,ncmreveroe side) ) <br /> ' ���m� work t�wN r�m �r� will �m done-in �«m�xdan«e with Som Joaquin <br /> I �� �� t� Yh� � �� �� � � � ���w �� �� ������ �� � �� <br /> | ComnMy ^�rdUmmnmeo �amwlan*s, am8 ��Ymm �w� �m�w � � <br /> ` n�� m���1�mUs�wrprm�r»ifie�theVwllowing; � � xm <br /> "I ��mH�� ���� Un ��� �w�*mm��m� m� x����,� fmn»����� ��Um permit Um tomwmd, U �hm1U �mm employ any person o�� mw����� <br /> as to become subject to Workma Compensaflon laws of California." <br /> - <br /> Signed <br /> ------------------------------------------------------- <br /> ' wy r ^---yT-' <br /> tv, other than "w.ir <br /> "=/ <br /> OR DEPARTMENT USE ONLY <br /> nATF —7 <br /> , ~~.^--- PERMIT ISSUED_ ---'-------'-' -'--.----_' <br /> ADDITIONAL COMMENTS ----_----'_-----_-_-__'_--'-'_--_-_---'_-'----' <br />