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<br /> M .FOR OFFICE USE: ;
<br /> C APPLICATION FOR SANITATION PERMIT FOR r: OFFICE USE,
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<br /> K.; (Complete in Triplicate) Permit No:.~L.. .-.
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<br /> ....................
<br /> Date.Issued a�
<br /> ...... This Permit Expires 1 Year From Date Issued tidy
<br /> " ApP�loatlon b hereby m6de to-the Son Joaquin Local Health District for a permit to construct and.install the work herein described '
<br /> it appllcorion is made in cohipliance with County Ordinance No.544 and existing Rules and Regulations:.+.. :::-..._,..,+�r
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<br /> M v? TRACT ADDRESS/LOCATION �.�� _. `.::,.CENSUS '
<br /> Owndr sYNcros.. L
<br /> Y= Phone:.�. ........ L:.,......
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<br /> dress 7? :.
<br /> Ca ttractor s Name V./��r O/�/ • .....city'.. !1a Zrp �r , t
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<br /> MAK
<br /> _........................ iClRbe ...::::....:..... _Phone „aj+';.
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<br /> hr:InsFallation Wil! serve ;' Residence Q Apartment Hous Commercial Trail Court
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<br /> z �r r $$�� Q i
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<br /> Mo
<br /> tel'Q Other '%C�rjT/1i�i!!7
<br /> &!Number of Itving units Number of bedroomr t
<br /> '<� r Garbage Gander Lot Sale
<br /> WaterSupply: Pubitc System and name ...... .. .. i rrPriva a '
<br /> • �abaraeter of soi!to a de th of 3 feet - ••.• - ••• -� ••-
<br /> 5
<br /> 1P Sand Q Sllt❑ Clay[] Peat Q Sandy roam❑ Clay loamw "
<br /> w:w f tri, �Hardpar +Adobe Q- FEII Material If yes,typ,a
<br /> IPloty plo_n showFng size of lot locbtion of,system..in relation to wells•build* etc,must be-placed on"reverse'side;�:
<br /> iR� .gym h
<br /> IEIN 1PISTAI,;ATION (No sept�c tank`or seepage pit;permitted if.publrc sewer Is aviiliable within 200
<br /> �sPACKAGE.TREATMENT~ SF
<br /> i f ] SEPTIC TANK f ] Size ��Q O
<br /> r J/ liquid Depth t ,
<br /> `g �'YMQtEY�QIry, r,Q A.hk ,-.. .
<br /> �� tic s 4C+ r�t Ca aCl �7 `` . r�
<br /> P ��'� t., C+T��'Nq Compartments t l
<br /> Distance#o nearest: Well. ,i ' ` f
<br /> Fourida�n r+a Prop Line
<br /> >EACFIING yes { .
<br /> EINE No of if l4ngth egc ine. ?° dotal LengtFi
<br /> ( L
<br /> }�r� *t D.Sox. ,_ ..T e Filter I 3 :
<br /> its , r. rL. Yp ^ Material... z .. Aepth F(IterMaterial ..:. k F�•„
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<br /> �: t'a :a� DistciRce to nearest:Well. -1 U� �•j_- .Foundation...:�0' /'� Property Line.T��' ... 21.
<br /> �'1•IT�. y ,r cit 1;•:c� � r c� y
<br /> AINDapth a "}.D(ometer F Number..." _ Rock F(Iled Yes ��I�o'w °
<br /> Water Table D h �... Rock $ixe' ..A
<br /> / ,f l ....
<br /> =`yDi a c 't noarestt`Wei _f�3 ,Y^' Foundation. Prop -Lin
<br /> I �ADD1inONb(0r nJ�i trerrnlf�....a 1x a ti av t e-t
<br /> Date.
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<br /> rP` Pt 4 , ' ments]' z ... - ..fit ....................................L.•°
<br /> w i:�w1t7" _tom ..�.
<br /> DisposaCField (S*If- Requirements]
<br /> .F!i.N,c"7[.., v. _._ At
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<br /> {Draw existing orkd required addition on reverse fide] r ta`a
<br /> 7hMi!b11.cowl I dt I hove prepared this application tin that.tfiework will b ."dqnetIn'aecordarh wlth Spm Jeagtilis Ceunlli
<br /> OraManox; 3tedeLawr, and Rirles end Reyulatfens sf_ the.Safi Joaquin local liealth.Distrieti.
<br /> Berne owner m Iicens�d,pyiMs
<br /> pri tine torliHis iiw follewinpi
<br /> jti,res+,'Ls�rtYc�.xk ` r"�+-'P-✓ + `' ;'1` r�:° ; . ° _ '�• -- '. � i�'-1� .. r! y - --
<br /> Iliac In Ike performance of the work far,which this permit is issued 1 jbeeEl not em le an s
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<br /> i }, P *, , e such mpnner,es; +
<br /> 1w , t P Y y person lr
<br /> n N�rtrt�su ]ect 1e Workman s. Cempensatlen Iowa of Califerela i ;t � ,
<br /> st ' rv• .;,�'•,te e 'c` ..
<br /> }} OWner i w e a 3 F t
<br /> T(tl firr ''H
<br /> IlfMother than awe+]
<br /> •�,s FOR DEPA 'EKlT 1JSE
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<br /> (zAPPLiCATION`ACCEPTED,BY DATE
<br /> ki`DIV15(OfJ OF lA�lDNUMBER .. DATE .. rJ ;
<br /> ,' %iDCITIONAL COMh+tENTS"
<br /> ... . »
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<br /> �Flnal Inspeaian byi ! f/f� :. Date
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<br /> t o!sSAN JOAQUIN LOCAL HEALTH DISTRICT, ras� villi iii'
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