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i <br /> FOR OFFICE_ USE I <br /> APPLICATION FOR SANITATION PERMITn <br /> Permit <br /> r <br /> (Complete in rip Cote) ` <br /> :.- This PerniitEspires l Year From Date Issued. <br /> Date issued '�` J G� <br /> Application is hereby Wade to the San Joogvin Local Health District:for a p er reit to construct and Install the work herelri ' <br /> described_ This application is made.in comp::once w th County Ordinance .No: 549 and existing Rules and Regulations z �. <br /> V. JOB,ADDRESS/LOCATIONd F: `(fit-�- CENSUS:TRACT•:- <br /> - ` Owners Name ---. gLs 3 k 5 <br /> F p — - 4 <br /> + Address :.-. --- "L <br /> ..--.. ciry <br /> 4V <br /> Phone <br /> - . , <br /> r~ <br /> Contractor's Name �Lt�l.Lt►. <br /> -sLr?'�`� License# =-. Phone . <br /> lnstollat,on will erve Pe•idence�Apurtment House❑ Com-"rcial T]Trailer Court ❑ ;: z t <br /> .. - ..s _ <br /> htiotel j]Ot'ier. <br /> Namur of living units ...- hTurnber of bedroxns ..- Garbage Grinder tot Size ..'.� Q- /��SV <br /> Water ASupply aucfic System and name .= .......... ._...................................................Private s X x <br /> Character of to a depth of 3 fee! Sand❑ Silt C] Cla <br /> cty ❑° Pea!'(] Sandy Loam [} Gay loam ❑ <br /> ' k rr <br /> Har dpan.0 Adobe Fill a material - if yes type ... <br /> t (Plot plan show+ng size of lot locption of-sv �-s;it relation to wells buildings .etc must be`placed.on reverse side 1F <br /> + NEW INSTALLATION:.'-' -(No septic_tank..or seepage pit'aermitted if public sewer is evadable within 200 feet,) r <br /> PACKAGE TREATMENT j ] ;'SEPTIC TANK t] Size liquid Depth: rj <br /> F Capacity Type'.- Matenal_.. iVo. Com/�artments <br /> r S , . <br /> c <br /> Di lance to. nearest Well rounciation Prop Lid <br /> )., 5 LEACHING LINE [ ) No:.of L nes ..--- Length of each (rne .::: Tota). Length .. <br /> t . <br /> D.Box Tyree Filter Materia['` Depth Filter Material ..... <br /> ark <br /> ' Distcnce to,nean s- Wei Foundation Prape line <br /> SEEPAGE PIT [ i Depth Diameter Num Rock'Filled Yes ❑ No Q <br /> �s :' Wcter Table:'Depth Rock Size <br /> •_ <br /> r, Distonce_to nearest:Well ..::. <br /> i <br /> ....... _ <br /> Foundation 3 .-- Prop. Lina <br /> REPAIR/ADDITION(?:ev.Sanitation Permit 51` Date ) E . <br /> y Septic Tank (Spec i} Requrrem nts). .. ...- <br /> Di;poral Field (S any ftequTremerits) s . <br /> xtRs-cam_ol .<rc <br /> .... ,.:. <br /> . <br /> r, alDraw existing and required cadltion on'reverse.sidel � 4 <br /> Y 1 hersby certify that I heli pripared tills op}Tiratiori rsnd'ihat t#ia work will l i• Bono Irr aecordanee with Sen Joaquin`: - <br /> County Ordinances, Stute Laws and Rules end Regulations of the San Joaquin Local Health District. Hame owner e, Inas . <br /> } sed agents sigriolure certifies the following: <br /> f a "f cvrti t>tat in rise perform <br /> of the'work far which This permit is issued 1 shalt not em (o any enun ist such 'Wanner " <br /> fY P P p y_ y p. '72 <br /> r <br /> as to become subject tr-Workman's Compensation IaWit of Califami7.' . <br /> 7 Signed ..-:...:. �.:.._ / Owner <br /> .... ..._ <br /> $ _. .. Title ". , '. <br /> < [if otFe s n ow�ier► F' <br /> FOR.DEPARTMENT USE ONLY ' <br /> APPLICATION ACCEPTEDBY................'.-...'....-.'ti .:...-.....-....:................... .... .QATE .. <br /> ...... ...:....:....�.! <br /> 9UILQ;NG PERMIT ISSUED ....... �' �`.. -�. :..............DATE .........-..--' ..•.._...... <br /> A.DDiTIONA: COMMENTS :...........:.......-......-.. <br /> ......------•----.. .............- .- ...-'---'. :c ....... .. ....::--.....:......... .................................. .... <br /> ......... . ............ ............ ......- ... _..-....------...... ...........--.-......-... .....-... <br /> v: . <br /> Final l:s;xtition by: ._ -._... ..- .... _..-�-�'lr/1L�..... .. .......... ...--"-'----"---Date <br /> SA.d JOAQUIN LOCAL' HEALTH DISTRICT <br /> 5' <br /> E.H. 4 Rev..Sir. <br /> e <br />