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.. .. -:- ..� ..:: ,, �...... „. :_• ,::s'='. ..ice. <br /> FOR OFFICE USEr <br /> J r APPLICATION FOR SANITA*ION PERMIT Permit No <br /> �( (Cae:p!stw in Triplicate) <br /> ,.....:................ , Date isiuee! <br /> This Perm: Expimt!1 Year Xrem b Iss�rd <br /> Apphcation is lwreby made to tho Son Joaquin local H"Ith Dittrict for a permit to constmIct and install the tlVar� heealft € k3 <br /> d"etil~ed.Thls cippllcation Is made in compliance with County Ordinance Pia. 549 and existing fi:ules and.Rebiuldt.mts: <br /> J. <br /> J65 A-6 D_R.i ,4.,C ATICW <br /> L r <br /> s `. Grvner'a,fvicentr _<.................... ............. <br /> AaJri�s :./sur <br /> icensePhone <br /> Cerdractar's Name <br /> Ga <br /> r <br /> I»stollutw.wilI serve: Residence Apartment House 0 Commercial 01MAer,Court <br /> - <br /> .....Motel❑Other ... .... <br /> Ci <br /> a <br /> - Number of Ifving I+lunber of bedrooms.... ....garbage Grinder ... . Lot Size <br /> Wes'er'Supply, psabllcSystem and name ... ...................._...._..._.................... <br /> ivate l� YR 4� <br /> Chatccter i:+f boil t6.o depth of$fact! Srnd ZJ Sift.❑ Clay ❑ Peat❑ Sandy'Loom © GGy loaitt >, ,�;`� <br /> Hardpan Adobe.❑ Fill Materioi .------.- .Ayes <br /> shc+a.lief arze or lot, location of system in,relation to wells boildingt, etc must be placed oes revs,se sir tt.� (N .. <br /> }, <br /> NEWIAfSTAlIkS1J (No toptac taA or stepage pit permitted if public srurer:is avatfable withiee 20()fdetl ` 4 � : <br /> PACKAGETREA'Tll'ENT ( ] :.a- KIC TANK 1.] - Size .... .... _ LFgv <br /> e <br /> Cap my Type . ........_ -.:. _.. Na Com' iparfinenf3 <br /> Materwi <br /> i)rstance to'.ncarest WeEI ....... ..... un art F'rap LMo <br /> tif Luras' length of each lira.-.-- Q dotal length ` ��� <br /> LEAdi1NG L]NE lid . ... _-__ :r Zrt- <br /> x ..r..... Type.Fiiter.tJijterin! ...._. _�� .DeAt <br /> Filter Mate �� � ,f; ��'� <br /> flistar fa:necrest: Wei i . ..:4P:. �... Foundation, / Property line77 <br /> i <br /> 1 <br /> ` SI:I:PPIT :,j� Deptr► .� � Diameter Number .......... .. /%otic Filled Yes <br /> ' 4. 6 <br /> Water Tablo Deptrt ...............t ...... .hock Siz^-v <br /> Distance to nearest:We ` .. ... __.•..Foundation 6� Prop. <br /> REPII$K/ADl MQN- {Prev ] ai;tatiors Permits _. ................... <br /> Date l 4 F <br /> Septic�� edfy lZegvirements) . ........ ......... ..... <br /> rrient� .. <br /> 151s 99 sad ifiel T p�fY 4 <br /> .. ....... <br /> w (Draw existing and required addtlior,6n.reverse side) <br /> x ' <br /> lwerwlsy urHf(v that l nava prepared this erpPlitaticn.and that theworlr will 'ss;done les aeewdana vr[Ilii <br /> s Coin Ordineneesd State:.laws, and Txuies acrd, Reigulatlans of the San Joaquin laai flsait% DisMct Nestspyawster <br /> re coriifiesaise foliewrn 9 i # 4 <br /> Q�YRn stgnYwty �• '._ ._ - -,. --.- _. 5k 3 a t*' � �c:%�3��� ;' <br /> KI pK}y fhol th lhrperfeiemansaR of.the work for which this permit is'lssuod,I snail not emplolr awry Romm,M wdt t7za 4 <br /> ~' ' as�a iiay+rme I� p s itf Callfo'mia.' z t <br /> to Worlenron's Com ensaHam law <br /> !!"� t ,.:� _.... _- ..._Owner ' +y:� 4 o d•`i�, <br /> yk <br /> 1 <br /> Sl fit �.,- - <br /> Tittle 41 <br /> �'�� 8Y 1 '� pf.iathher than t?wner! .. ---- <br /> FOR .DEPARTMENT USE ONLY 3 r <br /> ..„ -.- <br /> APiTiON<:ACCEPI ED BY <br /> DATE • <br /> i , B411lldll!i�' PERMR ISSUED _. ,. s... • ..DATA u .+ ! 4,4 a <br /> ADDITIONAL COMMENTS _._.._ ...... <br /> ------...: 1 _ 1; <br /> 5 .. .._..... <br /> Final;lrspectian by+ ................................ ....Date <br /> !: <br /> � sHEALTH l DISTRICT JOA UIN LOCA A . <br /> •' <br /> iW Rev.Jr�L <br /> E H.9 1 <br /> i <br />