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<br /> APPLICATION FOR SANITATION PERMIT
<br /> 1Cem isle In Trl lita#a, Permit
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<br /> aj ..:.: fThls Permit Expires 1 Year Fronti bah li;ued k'}.,j �-x"
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<br /> �Appllcatiomis heaeby made to the"San Joaquin Local Heolth, istrict for a permit to construct ond.Instali the workrherefn'tlef&
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<br /> appl€cation is e in compliance with County.Ordinance,No.549,and existing Rules and Regufatfons 'r
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<br /> C?B ADDRE55/LOCATION f� A �IIL. �SGrs C LENS r r�
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<br /> Ens�allationt.willy'serv�r, rr' Residence Apartmeilt House ❑ Commercial ❑ Trader.Court [❑1� � �� Y
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<br /> dir- 0'f+���ar Jak#f)h+ir a , 'F:Motel❑ Other ` ` .A.`r ' t ,y,.fyv; l
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<br /> +Itlmber of living units 1trr Number of bedrooms : Garbage Grinder Lot Size y r ;n
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<br /> _ INa�er.Supp,lYs Pudic System and name •• _
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<br /> 7�4� Clay loam[� '44�
<br /> haracter'of soil to a depth'of 3 feet rSarid ❑ Sllt❑ ,,Clay®` Peat❑ Santly Loam❑ ,�c j
<br /> Hdrd an Adabe Fill Material
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<br /> ["�l�F plan ssl ow>'hg s€z@ of Eot locatlori of system in refatlon fa wells;buildings,etc must be placed ar reversp�sldt,e�r y �r
<br /> �rr'1;'YA'r. .v vd�a�''AT--�,V.l;;•w.?rj i S'-4`sa hr a1 - {f <' �' - -r' r r' -.a:,e - -+5:' a r'�:.r r a a ry r '°# ��."F7xY' n,4r
<br /> NEW,�IN37 L�ItI�N U[No�sepfIctank or seepage pit°permitted if public sewer fs available�ruithin�2�O feeti : r `,«
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<br /> `RA KAGI:tREATIVIENTft[�j', 'SEPTIC TANK '} Si e, ^r �i p�P
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<br /> T��A'C#�ING�.LINF' '[�Qy'�'r''No�of Llnes���v2.' - Length of'eacn 11na:• � ,.. Total .Length?:M1r�4
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<br /> ibYu:. rl ;7���t D Box .�:.� Type Filter Material; �= Z epth iter aterial C qS }' ;•
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<br /> `'�`Dlstonce;to n@crest` Well 'lQ�.:.i"' ,tT y.FD'un�I-otlp�} r Property L€no,
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<br /> SEEPAGE .,�xDepth 1D. []t�metef Numbed 9 r� r t s„ Rock FIIEEyx1��YeY ,Y
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<br /> SLi/ '� S � L`�f ,Vtiater Table Depth Rack Size A,
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<br /> ' 3i"F1v yifl }ra`� rr Distance,fo nearest W@I1 �Q� - ' ”' Foundation
<br /> xE' Zc+"'a' ',.- In REPAIR/AbblTlOh (Prey Sanitation Permit# a „�� �
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<br /> tSe tic Tank`5 eCL r Re virpments}A
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<br /> Disposal Field (Specify Requirementsf<>r G [i /���i --
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<br /> it,:tYr4v�F1f-. ,rf4_f^}(Draw existing and requiredtaddition on reverse"sidel -.r a VSs. ?i
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<br /> t'=1,ereby,;cartTfy that-.' have,prepared this appilcaiionrand:,thatxlhe work^will bs done inl acco�dance��+ ihh San Jeagsllel Coif�nfy
<br /> lawstrh`ar±d�Rules'and aRegulations"of s the"Sari,Joa uln LocalrHeal'th°131stritt• Home owner or,Ilcanuet+aQe is
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<br /> sTgefature certifies iha following r a , 1p a cat ; g
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<br /> a "i'Cortifypthtrtzin Efh� perfarmance,of the work for which.rthis perinft Ts Eauad,al shall net employ any person Ilndtuclh tndn.Mr e
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<br /> fecomegs [get.. is rkman s,$�Compensation laws ofF Califotni c
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<br /> DIVISION OF LAND f DATE F 4 F.
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