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<br /> FOR•OFFICe USE,
<br /> . ........................................................... APPLICATION FOR SANITATION MMR
<br /> ........................................................ LCempfebleTdplkrsNs)
<br /> Permit Na.7L._L 24:-
<br /> .....................
<br /> 4-......................... This PerreHr Dab Issued.
<br /> Explm t Yew From Deb fumed
<br /> w Application Is hereby made to the Son Joaquin local Health District for a permit to wnslnitf and install the work 1 a
<br /> described. This application is made In compliance with County Ordinance No. $49 and existing Rules and Reguktflorta
<br /> JOB ADDRESSACCATI
<br /> l/ ..... .. .. ..r. .. .. ,,. 09VA uUS d.3.
<br /> 45..........�.....
<br /> . 891...
<br /> Owner's Name ...... . J .41G/ te.....JnN_.....................................................Phlore
<br /> Q..
<br /> Address ....... l�.7.2.7....�. hoe. .....�+.. F--,(C!-d0/-
<br /> a.......�C�xl!»/.........City..... , iQr ' 'n.�6 7t A
<br /> Contractor's Name.....Olr/[XV-1-..............................................................Liam I........................ Phone .........................
<br /> Installation will server Residence Apartment House C]Commercial(]Trolfer t out (]
<br /> `t Motel 0 Other.................
<br /> ppp Number of living units,.......... Plumber of bedrooms —2.--Garbage Grindw,&d...- I&Size ...,7Q,.i7.�..,�C/�F,(.....�
<br /> g Water Supply, Public Systmrn and name ..........................
<br /> - Character of soil to a depth of 3 feet, Sand❑� y j]Slit 0 Clair Pea 0 Sandy LM"X day Leen C3
<br /> I
<br /> Hardpan x Adobe❑ Fill Material............1f yes,............................
<br /> (Piot plan, showing size of lot, iut:ation of system in rotation to wells, buildings, eta must be placed on reirmn side,)
<br /> NEW INSTALLA410Nr (No septic tank or seepage pit permitted if public sewer Is available within 200 feel,)
<br /> PAC:CA_C•E TREATMENT [ I SEPTIC TANK( I She................................................ Liquid Depth ..........................
<br /> Capacity.................... Type .................... Material...................... No. Compartments ......._...........
<br /> :5 Distance to nearest, Well ....................................Foundation............... ...... Prop. Line...................
<br /> LEACHING LINE ( ] No, of Lines ........................ Length of each line...............
<br /> .ti
<br /> ............ Taal Length
<br /> .........................'D' Box ............ Type Filter Material ....................Depth Filter Material
<br /> Distance to nearest, Well ........................ Foundation ........................ Property Urw .................
<br /> SEEPAGE PIT [ ] Depth Diameter Number ............................ Reck Filled Yes )] No G
<br /> Water Table Depth ................................................Rock Size ................................
<br /> Distanc:u to nearest, Well ........................................Foundation .................... Prop. Line ....................
<br /> r RE►AIR/ADDITIONINev. Sanitation Permit# ............................................ Date .........................._......I
<br /> t Septic Tank [Specify Requirements) ......... .........................................................
<br /> Disposal Field (Specify Requirements .... +�Q/.,!L,.,.,-.....�,YIJ. .l! .•-•...• ...^•...••.•—•......,.••.....
<br /> 1.Scri*��.........�C.B. x.. ro...........o�'............C.... a�..........3.T........ S.z -..... r° ................
<br /> ........ .. ............... _.............._. _....... .__...... _.................................................................................................
<br /> (Draw existing and required addition on reverse side)
<br /> I hereby certify that I have prepared this application and that the work will be done In accordance vdtk Son JwRvle
<br /> County Ordinances, Stole Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ike,►
<br /> sed agents slgnoture certifies the foilowl;y:
<br /> "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner
<br /> as to becorne subject to Workman's Componsatbn laws of California." , ,r
<br /> Signed _._ ....................... .:_
<br /> __.._ _..... .. .......
<br /> By .... ... ..
<br /> . ... Owner
<br /> ... .. .._.. . . .. _._.
<br /> (if other than owner( Jille - - - - ----
<br /> -- �,v TM! T USE ONLY
<br /> APPLICATION ACCEPTED BV Y. r ��.� .,, _ ,.. DATE
<br /> 4 BUILDING PERMIT ISSUED .. 1. ..... .. DATE
<br /> ADDITIONAL COMMENTS .,�I%/�.D .. yt�lRLrt(j ,TGi."dr�3...,/�je.V1,
<br /> __,. . ..
<br /> Final Inspection by: .
<br /> Ell 13 24 1-6/3 !Lu"`l >r 7 5,,%N JOAOVIN LOCAL HEALTH DISTRICT Date /(J� M
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