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i <br /> FOR OFFICE t15E: ` <br /> APPLICATION FOR SANITATION PERMIT <br /> ......................•...... Permit No. .. _.,/�7 <br /> (Complete In Triplicotel <br />€ <br /> I ..... <br /> .............................-.. � This PerrtutExplres f YearlKsm DateIssued Date Issued.L3_:r-!226 <br />! Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin <br /> described.This opplicetion is made in compliance with County Ordinance No. 549 and existing Rules and RegulaHonsr <br /> i JOB ADDRE55/LOCATION �?' ---- `"�`�``' --/' "--........ _ _ CENSl1S TRACT <br /> Owner's Name ..:.)�Im ;...... :� c .. �� Phone•..�.........r: <br /> Address : .fl ... ,.-. ..�:: ° %.... ' ' - �.:.:. 1.............. ............:. <br /> .:.4„ 3 <br /> Contractor's Name .. .. .. iliceitise ::� .._-. '`Pliane ............... <br /> siderite rtenent Hoarse C-- <br /> -. �APa fl ircivl j�Trai erCourt'.{]: <br /> Installation will serve:, Re Mote1.0 bthr#r <br />{ Number of living units::.,. �_..,-:I+lumbe* ofkedo +irGbdl Sa . i <br /> Water Supply: Public System and name <br /> Character of soil 10 a depth of 3 feet: Sentl© Silt.o Clay:©' Peat[] rSandy Loam:© Ctay Loam.Q <br /> Hatdpan© Rdokre❑ Fill Material_ If-yes,':ty <br /> {Plot plan .ahbwirig,site,of..lot,,,Io[ation_o3 ay#terrr<..in. elalIon to. .eiis .bu didgs,.ctt..must.be-00:ced-on;rev";sidell <br /> MEW 1NSTAlLAT10N: {No septic Sank or,eeepagepit,perrriitfietl if,l?.Y.h+F:swer:es avt?ilgble w##Iti (}0#eet,} <br /> ,, _ ` r <br /> PACKAGE:TREATMEIJT I] SEPTIC TANK t6� Srze.✓�...�:.�f ?(•,�� _ .?Ugvid depth ..'.`E .,:..._'.._._..�. <br /> .-- -..... CopauN_ J..9.0 ` . typ.e.- <br /> .PA�'} ..,.-. . No. CompartmentM <br /> ........... . ....... s =- `------.•----- - <br /> i Distance to nearest: Wel! ; °. .. ........foEtndefiori-.. .' Prop.line;.__. :..._..? <br /> LEA0 ING LINA No. of:Lines Y...,.i <br /> I�; .: .. .;� ;. Length of'.each line ...:..�fl. '...•?alai' lerigth::._.�.?-o.�...a <br /> # _.- . � ..- '•"D"-Biiic-:.::'"1""'`"Type Fflter�-lU�a4eri61"":�.�.�-_..--_T�piii`F,Ttei"N1'dfeitdt'-�::.L�f...��<.::.::i:::.. -.... ..::_k <br /> i .�. -�• Dislan[eYp"nearesM-Wetl"•::'.•::��Q .��•foEtmdhtirni-.:.;'I!R:'F.f'T' �fkoperty Llste-:Sb�{_::::..J. <br /> S1j;PAGE PIT :[r7. Depth .... � Diameter -'..•-Numlier :::::::; .:::- --:. Rack RiledYei ( No Q <br /> ;. Water..Tabie.Depth•-•--._ <br /> . <br /> { ;Distance:to;nearest;VileE! ._'� .° �- +Fotindot�on `.'10„ Prop .line <br /> RiPAIR/AtlI3l71Qh(Prey-Sanitation Mermit 4 -- ----- ----------f}pte - __.... <br /> 1 <br /> jSepfic Tank{5pecify Requiremenf's} j <br /> .._ _: <br /> ispasa! Field (Specify Requireritents} ..-•.-.---•-.__._...__. ------ �... ...............» ! <br /> i .,_. <br /> :......:. ..... ..... :_.............. .......... - . .............................. ...... ---....-- <br /> (Draw existing and.required addition on reverse.side) l <br /> I hereby certify that 1 have prepared this application and that Eche work will-be done:In acccirdance with San J"quin <br /> agents si nature certifies the followte : ... : .. :. i <br /> g 8- : . ,.,.. ...llnn{a owner ar Ikea• ! <br /> CeuMti Ordinances, State lours' and Rules arid:Regulatlans of lhb Spiieagida [need }leolth pistirid. <br /> sed <br /> "1 certify that in the performance of the work#or which'this pernsft is issaed,if shall net wnptey any 0ersen lei such overt e <br /> as to becoiise subleit to Wsrkman'a:Cempansailors lawn of Cali nriiiar" <br /> e <br /> Signed -1:—...... - <br /> By.. c fele....:: - .. <br /> (If other than owner) <br /> R QEPARIMENT Wji- ONLY <br /> APPLICATION ACCEPTED BY...:.... .; . .: -....' :............r.._...:......:-_..._.. DATE ! ,2`-Z <br /> BUILDING PERMIT ISSUED............:,:_.. p ..,,. ....; ...... - -DATE i <br /> ADDITfONAI COMMENTS........:......:.. --...._.......... ........ ......�.........__.: ....._....;...................'...-............ <br /> .:.... <br /> ...... <br /> I <br /> ------ --- - <br /> ---......_'................ _.....:...._:. _ . ._ ......... .: .. ..... ... <br /> Final Inspection by .....-_- _.. ....__...- .Date_ <br /> _3M JOA4111N_LOCA(AkAtTFi <br /> I <br />