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- - t F <br /> { 'y�z�ilfN..r-�'..+ .•i� �r�3'r','�`°'�',�4g43f'�"' .-'Jo7;u- ;`'i.....;r:• .#;:.�1;•w a� r 1.LI�;' ��c'a� <br /> FOR.OFFICE USE: FOR OFFICE USE <br /> § ' APPLICATION_ FOR SANITATION PERMIT <br /> .. <br /> (Complete In Triplicate) Permit N a ; <br /> ` ; rrr✓/j o f 1� ¢zGo�• 2.f ata ss 1 y <br /> D I ued�' <br /> E . :.. ....... •-..-. <br /> 'Th Permit Expires 1 Year From Date issued <br /> ,.App'cation.Es hereby mad to the San Joaquin Local Health District for a permit to construct and install the-work herein describer; <br /> �,This application is made n compliance with County Ordinance No.549 and existing Rules and Regulations:.". <br /> p . <br /> S JOB ADDRESS L EON " <br /> 4 Gi3S ...... <br /> �s --- 7�W SUS TRACT r :�. <br /> ------- -------- <br /> ` , ,. <br /> _ n ...................... Zip".YC © <br /> Coniractars Name 5.C1�9 Qf' I�Q`C„LicensetlE��r`ST� ' ,phone...i7::�::/..517.io ` <br /> r Intiallation wiR'serve Residence Apartment House 0 Commercial❑ ',Trailer Court,❑ + <br /> Othe .... ..... ... <br /> S + , <br /> 44 1 y <br /> (Number oftiivtng units 1 Number of bedrooms... .Garbage Grinder.::: +_.Lot Size <br />' WWa Supply Public System and name... .........-. :.... :..... :` 1 ............,r`a'-`i_ Y • <br /> Private,��� . <br />} Character of soil to a depth of 3 feet: Sand p Silt❑ Clay Q Peat❑. Sandy Loom❑ :Clay loam❑ { ;h g t'i <br /> r •d <br /> Har an. Adobe F r ti. s ? <br /> P ill Maierial-_..-. ....If yes,type ....... <br /> i {Plot plan showing sae of l0; location of system in relation to'wells,buildings,etc:must be placed ch reverse side) <br /> ,.NEW.INSTJILlAT10N ;{Nosephc teak or seepage pit permitted if public sewer is avallabie within 200 feet} <br /> h '`PAWGE..TREATMENT • SEPTIC TANK �,k <br /> + _ I t l Sae:: liquid Depth , <br /> Capacity1� .. Materia <br /> t <br /> ,; <br /> ;Distance t0 nearest:-Well... �..... .....:..._Faun atlon _�....�...Prop. Line -1� `- r�ltF <br /> � � tet. <br /> {'LEIiCHING LINE [ t No of Lines..2'WQ. Length. each line ,� ,1�0 / .: Total Length..,. <br /> Box.:.-r� Type Filter Material:..I iptli Filter M te�lol F 1 { i +'� ` <br /> " O� .:. <br /> yy, n f Distance to neo gst: Nell._ Foundation.... Pro rty'.line <br /> SEEPAGE PIT ( 1 Depth:. Diameter.. rurn r....�` -Q �r _.... Rock Filed Yei No O <br /> 1 �, N <br /> btu .1 <br /> _,.. <br /> Table Depth .:.:..: �.�} �.. +� <br /> C� <br /> ,r:4 r} F "` i Dtatance to nearest Well.: Foundation.:.: Prop. Line 'r <br /> ,+ fi <br /> A1R/dAD)MON IPreJ Sanitation Permit i# a :.__ : - h <br /> •411 <br /> r . .....Date.: ....... ©. ) s. <br /> Sepfic Canis(Spkify Requirements) ......F <br /> Y Diskpcssal,Fleld {Specify 1 quirements} .- � q� <br /> yr #h <br /> d <br /> s Ds �t ��' 1 <br /> 5 t "> f ^+•rv,.-s-r+P*S ....... .. _• it <br /> f �r, s, (Draw existing and requi+,d addition on reverse stile} <br /> L herrbr aM/1r(hart I crave PP ' <br /> . Idrepared thls.a licption and that 1he•work wail 6e done toaicordanee witty San,Jeaqutn<CeuMi/�v.t <br /> ations of the:son lodquin Loral Health District. Nomeer linsed <br /> ��ri+aMasire cerNf�es� fellow! Ruies a,td Reyu! ownorce <br /> q� <br /> h; srlily thor,ithe Perfermana of <br /> ' + ich fhls Permit is Iswed. C shn11 not ernIthe:wfor whmrdn'e� <br /> r oy nY Person In su <br /> oWee <br /> .. comp" oq laws of.Callforala:'_. <br /> �g .:. ._. nor <br /> BY • ' s <br /> .Tlile... . .. ... r <br /> If other Phan owner} r <br /> FOR-DEP <br /> ARTMam USE ONLY �,. <br /> { f 'APPLICATION ACCEPTEb'BY <br /> ;'DIVISION OF'LAND NUMBER <br /> ••......... ,./) <br /> - - - ........:DATE <br /> `:ADDITIONAL:CbMIiENTS .............. a <br /> a i 3 .... # ��a <br /> x ._. ... ... ... <br /> # i r <br /> 5} r: <br /> e <br /> } _ .,M . f <br /> Final Inspection , <br /> . ..:.............:.... <br /> �r{ hc� <br /> is ze SAN JOAQUIN LOCAL HEARTH'DISTRICT' } r len'uv tn6 oµ <br /> k y f hl fi . �YSS.wstusd01Q a µ:Vi IID-5 I <br /> - - i vii-' Vii:; t.r:M .4F�i' 'sAft P <br /> �"'- f <br />