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FOR OFACE use, i <br /> » : APPLICATION FOR SANITATION PERMIT - <br /> Permit Nqi, n� •. . <br /> (Complete in Triplicate) <br /> ..................................... Date issued !.: �.... <br />............ <br /> This Permlt Expires 1 Year From Dale Issued ; <br /> ..,. p� <br /> Appllcotlon'Is herebymade to the San Joaquin local Health District for rmit to con and install the work heroin <br /> doscrlbed. this application I� d in compliance with Coun y Ordinance tVo. 544 and existing Rules and Regut{on� } <br /> ;SOB ADDRESSILOCAATI :CENSUS TRAC�f ,.. <br /> . ; ........Phone .... :... i <br /> Owner's Name ... .�en-e ...... ........................... <br /> ... .. -,.. S ? .. . <br /> Address ;.CrJ. �:�y? -� ..City , // .. ..:........'1: ., <br /> Contractor's Name..... . ? .. ............Llaenae # f�• �L�•�� done :.�� � � wi <br /> raller Court ; <br /> installation will.serve: rdal'�T � <br /> Residence(�Apartment ouse omrrta . <br /> Motel Q Otho... # ...............•......• ^l ip <br /> Nun>ber of hvinp units: .... Nurlr►ber of hPdraame• .Garbage Grind:r ....... Leat Size �� .. ... . ...•• <br /> .................. ...,.....«......r.................. ... .......«.Prh+afir.� <br /> Water:Supply: public System,and name ... .»........ ... - <br /> r a#nail to a depth of 3 feats Sand .' Silt 13 Clay•C1, Peat G '$a�y laatEit� Clay Laatn <br /> Charctch p. fill 1 Ye h►Pe.. . <br /> Hardpan 0 Adobe C' MaNrla .... . . <br /> IPlot plan, showing state of lot, 1OWIOn Of system in Wallon. *wolfs, buildings, etc: must be placed an rawrta <br /> NOWiNSTA1.WTIONs (Na sceptic tank ors It 200 feetJ <br /> itted if public aawer is available within <br /> a+p� P P� //�� r��Uq <br /> /J�[p', <br /> �- .I•i1Y••,Y•,•-rrrr-. Depth .F •.«M 1 .M..•• <br /> PACKAGE TRLA1`A MOT 1:1. SEI iC?A 3 Ske..• ., •:. .. : <br /> Ca � .. <br /> rtrr»nts <br /> laaciry <br /> Distance.to nearest: Wall .. Foundation.../1 .. . ......Prop.Lina-� <br /> 11 AC#iiNG LINE <br /> Linea ..... . length Of eQdi line. .'�..�.r:.. .. Tatar le10,1010,10 «« <br /> l�lriteria .. <br /> ....... ........ <br /> .. <br />` 'f?' Bax Type filter Ntater Dopt� .........r <br /> ..... h Filter <br /> Distance to nearest, Wall ..............�. .. Foundation, P rtY lla ."' <br />! SEEPAGE Pir ( Depth ., Dlclntietelr •. Number ...:�. Rode Filled <br /> Y 7 <br /> ... <br /> F Water Table Depth .......RD&$110 ............................ <br /> Distance to nearest: Wets ..................•foundatiorl4 ...,;. prop. lino .........«..-.... . <br /> .,.. Date ..:....:�....;.. <br /> EpAtR/ADDlYION IPrev. Sanitation Permit 911--• ..:.. <br /> - Sepik dank{Specify Requirements):...:. .... . . .. . ..... 3 <br /> ... ...... .. <br /> i Disposal Field (Specify Requirements) .. . <br /> i }........ ------------------ .. .. rnd required add)#14n�orti reverse.sk�ej.......... .. <br /> ... ---...--- <br /> (Draw existing a q - <br /> # !' hareby certify that i have prepared this application and that the work will be Mona in accordance with Sao W� . <br /> County Ordinances, State Laws, and Rules a:nd Regulations of the San .t4.aqule Local Htal;b,41tlriN.Hots owner or liar <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit N lea" I shall not ediploy DRY peneti iii aide e1 . <br /> as to bec a su 'ect to Work 's Compensation laws of California." <br /> Signed ---- -- .. ------- -------- - Owner :... <br /> -- -- ----------- ............. ---------.. Title <br /> (if other than owner) <br /> FOR DEP RTWENT USE ONLY <br /> ' � .....---... DATE .. ...:...... <br /> APPLICATION ACCEPTED By ..... .... ....... - '._. 77 <br /> _ <br /> BUILDING PERMIT ISSUED ---------------------------------------------------•----------- •-----------••..._......•.... --•--•......... ....__.PATE _.... <br /> ADDITIONAL COMMENTS ------------- -- ... .... . <br /> ................... ..... <br /> ... --•................................... ......... <br /> Inspection b <br /> ............Date ..... ...... ...................... <br /> Final Ins <br /> P y- ---------- ----------- <br /> DISTRICT 8/7h 3M <br /> 4 EH 13 2L1-6f3 Rev. 5M AN .IOAQUIN OCAL HEALTH DIST . <br />