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� <br /> FOR OFFICE USE: <br /> � APPLICATION FOR SANITATION PERMIT <br /> Perm� No /��.�_�'=��� <br /> (Co,nplw*m]n-Triplicate) <br /> +~ � ' <br /> � D�� }onue6 <br /> Th� _ r �~ ------'- - <br /> Applicationto the San Joaquin Local Health District for o it to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> 9�_ -P <br /> Installation will serve. Residence partment House,F] Commercial OTrailer Court 0 <br /> ^ ' <br /> Motel []Other -------------------------------------------- <br /> � <br /> Nom6o, of |ivi - Num6er �Voto, Svpp/y. Pub||cSystyn on6 � xo [l/ � <br /> 1 <br /> Character of soil to odapth of feet. Sond�j Silt F Peatv Clay Loam <br /> � <br /> _ <br /> �] <br /> ' '4�� <br /> HorJponE] Adobe ��~��U88ohario|�'=. --- Ifyes, type ----------------------------- <br /> (Plot p|on, showing size of lot, location of system in pa|udon to vvo||s, 6vi|6|nyv' 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 <br /> ' ^"p""'r +°`=---' 'xp� =�r'nu/�.'u/ �.�^ pu,xn�nm .- ---' ^� <br /> Di»tunce to nearest, Well <br /> -.�_' �-_��----�. <br /> .����-^�. <br /> .�---- on � - Prop.'Lin_a� <br /> --- <br /> LEACHING <br /> LEA[H|NG L|NE No. of Lines ..' r.---- Length of each 1i -�'-� iota[ ._ � <br /> .~.�..-. <br /> - <br /> 'D' Box AV�}.. Type Filter --- _ . DrptK Filter Na�,|o> ___//j------------------- ----------- <br /> Distance <br /> --_--- <br /> ' <br /> Dixtonceto nearest; Well .,~.~- - -' Foundation -/----- Property Line .~W_-_----- <br /> '^ <br /> SEEPAGE PIT Depth 6xw � Diameter. Number -- ------ Rock Filled Yes 0 <br /> Voter To6|a Depth -. ~ - - ---_-.-RuckSire =--------------------- <br /> / <br /> ----_----' <br /> / . � - <br /> ' <br /> ~/ <br /> D|�onn:`m nearest: Well -.. �--.---.---pnvn6o�on -_ Prmp Line ---_-'''REPAIR/ADDITION <br /> U,nev. Sanitation Pormk# -------------------------- Dote -------------f----_'_'-) <br /> Septic Tank (Specify Requirements) ---------------------------,__--`-'--'__—.—._.-_---_._._'`—__---_' \ <br /> ' \ <br /> Disposal Field (Specify Requirements) -----.--_-'_---------.--------------.-_----.-----.-' <br /> . <br /> ' - �- <br /> - -------- ---------_--'^---''-'-----_--_'—_-_----_-- -_-_'__---------'-'-_--.. <br /> ----------------- ----------------------------------- _--------------- ----------------------------------------------------------------{------------------------------------------------------------ <br /> <Dnzm,existing and required addition onreverse sida> <br /> | hereby certify thmty have prepared this. a��Yicm�ou and that the vvw,k m/|;| be done in aw«mn8mmow with Som Joaquin <br /> Ordinances,nd|nanwes, ��^mne Laws, and Rules and Regulations of the San Joaquin Konm|.HeaYvh District. Home owner or licen- <br /> sed agents signaturef the following-' <br /> "I certify that in the Rerformance--*f the �vorW for which this permit is issued, I shall not employ any person in such manner <br /> as to become suble'iilo Workma s nsation laws of California." <br /> I w <br /> (If other th ner) <br /> FOR DEPARTMENT USE ONLY <br /> oo/Lu/me pExox|r ISSUED ----------------_-.--.---_-..-:--.--------- ------_DATE ----------------------- --.-- ' <br /> ADD|T|ONAL COMMENTS ---_ ---.-- � Avd - <br /> '------'---'--'----- - - - -10��--'D'��'-1�''1�' —'' �---''----'---- <br /> ---_--'---- --- ---'---___-------^.__--_—^--������^^—''°~.~.~._.—_''----- <br /> '— �-------'-"���^'][�� --------'----'------'----'— ll�— -- <br /> Rno| |nmpociomtby ---'�^^~.���.>(0�t-'--- - - - - -- - - - - -- ---------'—'Dote .!�����/°°.'_ -- <br /> SAN JOAQU|N LOCAL HEALTH DST0CT - `^' <br /> E. H. 9 l''66 Rev. 5M <br /> � <br />