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<br /> :,. FOR OFFICE USE; hl 7'/ .:/OS
<br /> II•,// APPLICATION FOR SANITATION PERMIT
<br /> j . s:................... .k)0,e�.... Permit No. w :'
<br /> ... �"p.....
<br /> (Complete in Triplicate) .A 7'3� ,.:' s; .-a
<br /> ............
<br /> �I.
<br /> Date issued .. .../� ..
<br /> d
<br /> ' This Permit Expires 1 Yeor from DaIs Issued
<br /> ' �.. { �errnit to construct and instoli the work hereln .F F0. fi
<br /> u wApplicatian is hereby made to the San Joaquin Loccl Health District for a
<br /> described. This application is made In compliant© with County Ordinance Nio. 544 and existing Rules and Regulafianss ,-,
<br /> "`u:lOB
<br /> ADDRESS/LOCATION 1..3c�. ...... ....:1R �►. .........,.....CENSUS TRACT
<br /> Owner's Name ... ...Frzf� -... f4}.� .............._.....��. . ...................................Phone
<br /> Addreis " .City -�ICSD..a�.._.......................•--...
<br /> " License -'` ne : ._.-4.t�1
<br /> .........................
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<br /> Cor•rt rime......� 1�.�... f3K ,1.5. �..... .... .................... ` ►�.`F3... Plio
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<br /> w.inatalldt.sn will some$ Residence( Apartment Novse Commercial oTrcilor Co
<br /> vrt
<br /> b Mwe;❑Other............................................ .
<br /> 41
<br /> y Nurrrbe'r!of ]ivinj unites........... Number of bedrooms - -.,.Garbage..Grinder_.......
<br /> ....._Lot Site .. �y► ;w
<br /> i` �fIYQte••ly
<br /> T
<br /> �+ 1hl�ater Suppio Publksyttem and name i,,,,-•_•_..................................:..................
<br /> F b
<br /> r o A ❑ ❑ y ❑ Peat Q Sandy loam'1❑ Clay Loam QC,"�
<br /> �ChCte f:r3it fo a de th of 3 feats Sand Silt Cia
<br /> Hardpan❑ Adobe Fill+terial............If yes,trjpe..._._.......... qhs
<br /> t �7
<br /> {P{lot pian sFrnving•siYe,of lot,'locotion of system in raln,tion to 3vells, buiidings;;atc. ,lst be placed;on rewtnetsld ]
<br /> 414
<br /> 1p
<br /> £,fs3 1� fNSTALL'Ar10Nr (No septic tank or seepage pit permitted if vblic sewe�Eibble^vi t}1t1r20dfe�t], s '
<br /> ..
<br /> Size....... �..... ... Llquidt Depth
<br /> ' 7�g,PACKAGE TRE+4TMENT; ( ) SEPTIC TANK� � ._ No
<br /> Capacity Type .................... Materialeri ................. ... rorrapartmen"s � ,;��
<br /> Foundati Prop
<br /> Distance.to nearest: Well .....:................. ...... •--....... _
<br /> / LFACHING
<br /> ' lma
<br /> . Toalenet
<br /> No.° fLi . .................. .. . . �LWLeng�h3 ereach
<br /> b, box" . Type Filter Moteral
<br /> - xis
<br /> .r„s .. ......_. epih Al ....
<br /> _D 1 `"Mb�te`
<br /> ;. + Distance to ,zorests Well on ....._...... Property Luse
<br /> ... Foundation i
<br /> 1'
<br /> EPA
<br /> r water Table
<br /> :...... :.R• �tZ�e
<br /> oc
<br /> EPAGPiz • �Depss _ ......... Diameter •--- Number
<br /> Fl
<br /> . Y.
<br /> �
<br /> • . ...�..� R..Depth -.......-...........-- ..............�
<br /> A
<br /> sun alt .......................
<br /> ...................
<br /> to nearest:Well ........................................ d ,
<br /> F on M Prop. Line
<br /> e
<br /> > LisAIR/vJl� t "N
<br /> rF" t 7
<br /> ....:. Date _-
<br /> <0.4(pre sanitation Permit# ................
<br /> r
<br /> �tfi f
<br /> tio16
<br /> ............ —......._...
<br /> csfY e u:reme � �
<br /> ntslSepticTanM
<br /> ,Dtspo.^ t�eiz I 'f�rY.”Requ rementsl `tSa.................... •.
<br /> J Y �t] 4
<br /> ---------__------ ._-�._..f.�'... .. .._... [. `�'/.1.'...- - .................. ..
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<br /> _ _ .........._�......................... r.
<br /> c, z ........................................ .. ..._ _ ..
<br /> (Crawexistin.4 and required addition on reverse side}
<br /> 1 hereby certify that I haven prepared tuts sap)xPrr6on and that the work will be, done lin accordancR wttti Sari,loaquin t
<br /> —.6' County.Ordinancoi; State Laws, and Rule: and I:egulations of the San Joaquin Local Health Dlstrlct.°Home"ownee'of Eidtr.q
<br /> }r� f4d agents signature le"fles the following: ry`" ff'. }+
<br /> -rt. .r:th.. in ll:a poifarn+a-yes of the work for which this,permit is issued, l shall not ernpleTl any pfrson in such nranttec,` F`
<br /> w
<br /> nos to bI ., -su>aleet to Woes n's Compensa!tan lwms of Ccilfornta:'
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<br /> c]wn �� i Y
<br /> 4. u ! 5 •.� - � ..-....................... .............
<br /> 1I ifle �
<br /> —a er.tihan owner)
<br /> U:E ONLY ..........
<br /> r y t s
<br /> y € FOR DEPARTMENT
<br /> R
<br /> ............ DATE -_.��..7
<br /> `APPLICATION.ACCEPTED BY ..... ..............
<br /> .......... ........................................ DATE -
<br /> w: ,��•
<br /> 'Bt,11LDittG PERMIT.�155UED...- .. ..._ . .. .. - .............................. .
<br /> r..
<br /> 'ADDITIONAL.' :. �... `�...-.--• •z�.!
<br /> } ..........L.... y,!' fir . o� .... j �v
<br /> :..j .....sof..g •�*.x,l...�?.�2:(..t.•l'1............. ...................... ..............
<br /> .......................... f ....
<br /> :• '.......`� '-•• Date: ..to,f ,/�'... ....`.
<br /> F1naT inspection bye ._......s,-4:, ....... ._.._........................................................ .......... .. ...::i
<br /> SAN JOAQUIN LOCAL HEALTH DISTR!C
<br /> 24,_ .�_.... . 7/72 3 M
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<br /> �' '• '.s 13 '.�1.6$ Rev SM
<br /> H�fF� N4� � D..•$b 2
<br /> tam�Af- f p 1 eY,i
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