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.e <br /> FOR OFFICE USE: APPLICATION FOR SANITATION"9ERIAtr permit No. Jy �Q <br /> (ComPlitte in <br /> b2' ^�...... Data Issued <br /> .. .... .. ..I........I........... This Permit Expires Year Date the work t,ereMt <br /> App4cation Is hereby modu to the Son Joaquin Loco] Health District for a permit to construct and Install - <br /> : described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations'.,.. <br /> \ ° 4 <br /> .. JOB ADDRESS/LOCATION esus TRACT <br /> T <br /> 4Lp Owners Naim-7a Tie s rTN`2(/��...................... ... .... . .. 7t. <br /> § 4 - Address _./i.d°. ...� I I............................:.._............_City..ri.l7. .. ... •,•rr+�yir, <br /> Contractor's Name.._.rQr . i`!!L!E�. . .. .. . .......... .... ..............License Its <br /> Instoltntlon will serve, Residence Q Apartment House C1 Commercial❑Trailer Court - <br /> - <br /> Motel Other ................................ <br /> E Number of living units:.. . . ...`., Number of bedrooms ............Garbage Grinder .... ... . Lot Size ... F <br /> Writer Supp!y: Public System and name . .. .._.....,.............. . .................._.......................... .Pr <br /> Private <br /> '+ I Chora-ter of soil io o depth of 3 feet, Sand❑ Siit n day Q Pmt Q Soncly Loam in <br /> Clay Leam C <br /> Hardpan Q Adobe Q Fill Material . ...,If yes type....-I .... <br /> fa bt pion stwwing size sf'for loeanon of system in relation to vrolts, buildings, eta must be placed on reverse ,/ <br /> 14rH <br /> .f}£W lNSTALLAT18N:.' No septic tank or seepage pit permitted if public sew <br /> Is available within 140 ft»t,l r !r <br /> 7. <br /> PACKAGE TREATMENT ( ]. SEPTIC TANk f ) Size. ..... q rat!+ ..., <br /> Copocity , ::.. . .._. Ti PC Material . . _. ...... No Canepcetmems <br /> ,� 6>• ..Distance to nearest! W611 .. .. . .. ....: ....... . Foundut'on .. .. Pimp. Line .r•� <br /> 1 <br /> -- '- __..... . 7otai engffi <br /> t%ACHiflC,L!h'E ' (] -No..of lines - Lenyth o� each line <br /> _ 'D' Box .-. . : Type Filter Material ._ Depth Filter Material ^ <br /> Distance to nearest, Well ... .. .. ..... .. Foundation . . . . P•oxser`s Line <br /> pKuv <br /> . <_ •.'.: Rock Filled Yes <br /> SEEPAGE PIT (.i Depth -. _... Diameter ............. Nvmber. _. <br /> Mater Table Dept'tl- F <br /> ....................................- Rock Size ..... <br /> -Distance to nearest Well ........ . . _...._. ...... <br /> .Foundation . . .. ..... Prop. Line <br /> S R. . .. 4:. <br /> .- ..... Date ..I ...... <br /> �,- t9Atk/ADL'•R[T Utd(Pro..5anitation Permi•t9 _ _ <br /> F' ;Septic Tenk'iSpecife Regvirementsi_.: .... ..... ...... .............. <br /> ±, Disposal Fikid 15pxifjr Requ;rementsl <br /> ... . ...... <br /> ... .............. .............. ...... <br /> � - (Drc'wr existing and required addition on rt.der_t s' :at .r i4'ta�. <br /> ?7'1! <br /> 1.heraay rortif-g that I have prepared this appirccidea and that the werk wilt be dam in eccarnanca wlih San . <br /> Gcunty !)rct:ncnc_:. State Laws, and Rules and Regv,ctions of the San Jooquln Local Heal4h Dlahict.Hama 6svner er Ilea` ''tia"4 <br /> * sod ovaees uynarure terrifies the followins: - - . .. ";. <br /> c,WtKV Hot in the performance of the work fir whith this permit is issued,I "it net employ grey person ire tae.4 ansrnrsal ; <br /> T as ?o become sublac4 to <br /> .i yrCo/mgtnsvion lows of Wifemia. <br /> Sigrd ... Owner <br /> 1 , <br /> Site .: <br /> pf other then owner) � .. � � - s <br /> Foit orfAaTMENT USE ONLY _ --- <br /> ' APPLICATION ACCEPTED BY .. . . .... ...... . DATE . ��' .. '/ l <br /> „r d <br /> BUILDkVG-YERiWii-ISSUED.— '.-.. .��^ ... ......._. _-DATE.. ... .. <br /> _ ADDITIONAL COMMENTS <br /> f: <br /> 1t lea, <br /> .. <br /> Final Inspection by ...... ... .......Dote. . .. _ .... <br /> SAN•JOAQUIN LOCAL HEALTk DL9TRILT . <br /> 7/723M <br /> '.�.w E.P13 241=68Rev. 5M <br /> x <br /> fir'.!. . ______ nm�..sr•a.wwaiV� - .. <br />