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Y, OFFICE USE:.
<br /> APPLICATION FOR SANITATION PERMIT
<br /> Permit No(Complete In Triplicate)
<br /> It tic irk: 1 Y r, ro Qatta lisue+ Date;Iss�fed
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<br /> lication rs hereby 9made to the-3an Jaaquit"r ,L-ocal-Health•D'rstrict-•for a er `it to co: struct dud (nsta#1 1ha v rlr in
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<br /> Thus appiicption is inade_,in corraplignce;with Caiunty Ordinance No S49 and ex#stingy Rues and Regvlaticns
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<br /> XENSUS
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<br /> ddress ................. ' ...3{ ;. .. . __.. .. ........;City -- ---
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<br /> Contractor's Name
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<br /> /tinsta!lotion will serve:: Res+deuce❑.Aparfinent Hous$0 Gommerci"ai ]Yra ler tvourt
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<br /> !Mate! d Other.: .. .. ... ;. ..
<br /> Number of lining.unifs•: _ :::`: Number ot~'bedrooms :Y.::: : :Garbage is^rin
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<br /> ',,,,Private Water. Supply: Public System-and--risme --- - -__ .:: �:�:}_:.:.a..L�.-_:.:.:,��..: ,•:�:.:...:�::.,:�.:._-::::�.��:.::.,.,:_:::€,•:.:..-..:.1• [1-.....
<br /> Cbgracte►;of soil ta,a depth of 3 feet . San l:� Silt.p-..... iay..0 Peat-Q......Sonidy_Loam. ]. ..,.Clay.iloom_Q..... .
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<br /> Hardpan„[
<br /> Ado � F€H Material lf•Y.i�s..tYPe...
<br /> ( lot_plan;; showing-size of-lo.f-location of-systern,-In',relation-to-•r'vetls;-•buildings; etc:;muOt Ise- plaeed- ori. reyerse'sfte.I
<br /> NEW.INSTALLATION:.-;. (No-septic tonk..or._seei age;pit:;perrtaitteid.-If=VubliC•sewei..is,6vail;able-with .100.f eet.-I
<br /> f?ACKAGlr'TREATMENT,_I.J.. SEPTIC TANK j,}. ......-• :.. --�tzet-... .-r..,---�... .t.
<br /> p Capacityyf?e :.. Maters . `...... ...__ : No: Ccmprtrrients
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<br /> a Distance tb nedrest:' Well ... .. .Fpunctatlon -_ -`.... .. Prop', Line ..
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<br /> LEACi=l1NG LINE [ ] �#Vo. of Lines' ; Length of y each like. Total Length - ---
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<br /> pe Falter Mcited6l ............. Depth' Fifter Nlotetial r.... I. .-
<br /> Distance to nearest: 1N 11' .: 'µ” _ T`dund6f oh - : -.t -- Pro}serty 4lne .... _ .. ..
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<br /> 9El PAGE PIT ,[ l Depth"P ameter { Nuiritie'r':---:.: ::::: :_----::': hock"' lleci?" Yes ' ] :No
<br /> .... . _ ,.. .. .Water;Table�D:eptly ,.:.^ :Itacic'Sz$ : ::_. ::.. _i:: _ ... ... ; ...
<br /> i ' .. ... ,:.. -Distonir,e.t6,nearest:.Well-. :.. r{:' _''>:::: ::_::, found+ Hors•::: :::.:. :•:::::::• PFop: link
<br /> REPAIR/ADDIT10k(Prev.-Sanitdtion`I'erir�It:#.--._..;•.t., ..... . _.._ ..�.....` �......
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<br /> 'tic Tank;(Sp6' Ice `uiretrtents .. ::: ..:::
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<br /> Disposal Field (Specify Requireinerits) _ _ {------ •--- :....• : •
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<br /> ._.. '(Draw'existing-and iequifec#�dditiorron,ieveise-s4dei ... .;. . ...
<br /> dt hereby certify that I have prepar!ed,.this applttat>on.• nd:that!..f1rq..w�rfc„ rIII,,ba..idana in .AssoFdrltlse;.Wf1.h..S�Elet..JRgq. In
<br /> unty Oidincinces, State Laws,_anei Rules=,'and 4Re;ulaiions of the San Joaquln;Local Health District: Hain* bwner or lien-
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<br /> std agents"sighatuto c4rtifi0:t't6'fallowing:';.,_...:i ......._..,. ..,.,.M.............. ......
<br /> ";t certify.fput.in lie.peeforinaetce of,tti+ work.fir whlch�this..peKmit..s.is.;vsc#a.l.shall, nat.;entptE.ay.stt+y.;per an.in..sach.Titan er
<br /> cis to become fublect to Workman's Compensation laws• of Californlim."
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<br /> U V'1._ ... _ .. ._�.... Tit e .. --_ - ... __ .. -------- ..........
<br /> - If other ban'awi�er " ....
<br /> 0R"DtEPARTMENT USIr NL f-
<br /> �PPLICATI,ON ;ACCEPTED BY� : --
<br /> �- ` :...�a - �....... .... ... ...DATE..
<br /> TI-WING. PE0'kVIT"ISS(EQ`---- ----- - ----- --------------------------------- ------------ -------......DATE w: ...............
<br /> ADDITiONALCOMMENTS ---------•----------•----------•------------------- -------- ------------------------------ ----- -• --•----------- -------------- ........._ ........
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<br /> FindlInspection b .............................................................. Date .... -........ -----• -•---------- --------
<br /> EH 13 2h 1-68 Rev. 5M SAM JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M
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