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<br /> OFFICE USE
<br /> APPLICATION
<br /> FOR SANITATION PERMIT
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<br /> Jt`x r K` (Complete in Triplicate) Permit <s 7
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<br /> G .�41 This Permft Expires 1 Year From bate Issued ,lJate issu
<br /> r 'r frAppli atior is"h'reby n ide+o the San Joaquin Lar,Ql Health Dtstrict.:fora permit to construct and Enstcll�the;wf .rk�(iarefi
<br /> r ry?Y z descrrbed,This applicat�o� Ys niade in compliance with'County Ordinance-No 549 and existing Rules an d,RegUldtiansit.
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<br /> °s � JOTS 11Di7ar55/LOuATION ;tJ 7�..5 S . :. s C!�JL of C7 IrQ.i..1/T ..CENSUS,TRACT
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<br /> ( JOwner s Nrine }`kri LQ Phone
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<br /> a Address,
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<br /> wkrr Contractor s r License#'. Phone ' t uT � � •_
<br /> y����.E'�'�,7�d 'S'JY�a n� f4 I �: -ryt 0.lnstaRatlon will serve Residenc ^ so❑ Comm..ercto, [:)Trailer Court
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<br /> rata �tJumber(of IW1ng un tsi Nr►nYber, of,bedradrs Garbage Grinds . Lot SizeREI7�•— ;'
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<br /> rWare fSupplyY Public System and ntsrre I t $i Private
<br /> iaracter�of so,l to a Cl bf 3 feofit'� and[] ❑ a Clay E]g Pmt❑ Sandy Loam❑ Ciay�Loc+m vt }y
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<br /> vt� K, t . ,, �, �• err Har�lpa Adobe..❑ F!IiMtitertal If yes type '
<br /> r � Plot°plan,'showing siz3e of lot, �ocatlon of system'.in ` eldtian to vie buildings, etc must b@,plated 'ot"reverse =(dei}' .
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<br /> It§1STAIlIITIOMi ''(No s@ptic tank or seepage pit arrr.rtied if.public sewer-is av la4ile With ln.2t 'feet,
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<br /> � RPfKAGElTREATMEN7 i( ; SEPTIC TANK j ] SiZ3 Liquid Jepth .F "......
<br /> ... �,': J 'Ell +F'ynay 1`Fa57"."T'"'rsyru
<br /> g Ccpacr`y Type' Material No Compartments°
<br /> nearest: Well t < `' ; Foundation yPrbp�zr.tne
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<br /> CA�HING'.L(NE," j 1< �No of Linesry L ngth' of @ach°Ilne ', Tota!°length,�a ?
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<br /> Type FYlter Ma erial AAA
<br /> Depth Filter Maternal J
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<br /> 1, , Distance to nearest Well Faundaf ian Property Line
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<br /> s,� c�5�5 Pi4GE�P1T', [y)-��,r Depth_ rar � � Diameter Number{� ti Rock Fllled� -Yes ❑���No�� ''r
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<br /> �ae1t' "�,.s Wafer Tabl@i Depth y ` 'ROCK S7ZB
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<br /> zx ,r'r i�r�+Distance to nearest V�ell Foundatiors Prop. Line
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<br /> EPAIR ADDITIO (Prev Sanitation Permit# Date I` w'1rrg
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<br /> x Sep+ic Tank (5 @Gify1Requiremrntsl. L }- l
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<br /> ilR DESSoi3Ol FJeI S ecif Re uirements) .:¢� -.-.. �G �^ t yi s t {, iy._iv
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<br /> s4 ��i hear b'y",c&tE/ythat[ h`e'e pF�pn•1%d Sthis pp!(cation and.that the:'work,wTH be done in':acv rMrsce with�San lobgtul11
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<br /> vjN"?4�Cour`ty Orclinances�tata�arvs a 614`les and'lt Iahons of the San JaequTn fecal Ffeaith DisMct:Hemrovmerror
<br /> " ssd ah�e tisignature rrtifEes the foElowing a' wok y z s , § y{rr� f �kS>
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<br /> work for which this'permit ii ia"J' .l shall notemploy ,penHn such manner Fas to be sublk*A;t Wdren:atlen'lawsof California +✓ y ...Sig ned' ; - QWner s4'SEr 5-';tK a ^•, $ +`Y4 p�'x�,ljkr
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<br /> �a '•S''AG�i'' d <as' •tis'`Sy 4 Jt >. _• y r , r -ONLY:.'
<br /> fOR DEPARTMENT;US -ONLY:.'
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<br /> ,APP.LICAT(ON:,ACCEP,TED t- (7 , ' ti
<br /> ` rrS7'E3UILDING P;.ERMITISSUED
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<br /> IADDITIONAU COMMENTS -,;
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