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<br /> 14R,C FICE'USI:'= :APPLICATION FOR SANITATION PERMIT 3
<br /> r Permit No
<br /> , . ..7
<br /> y (Complete in Triplicate! � ��
<br /> ° Date Issued. . .tee
<br /> ' r1 Tiris�It liNpires 1.Year From Date Issued
<br /> ;f Application is hereby made to tf�p San Joaquin Local Health District for a permit to construct and instal! t1se,;work fiersir.
<br /> �,dfsui edE4Thli,applfWI*nrI made in comol!o'nae with County Ordinance`No. 549 and existing Rules and Regulrnions�
<br /> JOBf ADORESS/i.00ATION ........... ••. CE{VS115 TRACT `�•?`�, r
<br /> �- .. .,..... ,.�............ ..Phone.;�l.r�.-•-=���» F ,+
<br /> ^ ...............City. �r. .................... . -
<br /> ` l�L .,License : Phone
<br /> Contactor Name; ..'..' } .... .......
<br /> ' f stallatlo�.will serva� ,, x` +. Residence[Apartment House 0 Commercial [,]Trailx Court � � F
<br /> MotelOther ........................................
<br /> IV�smber of liv1wunits,. . f .Numbir of bedrooms. Garbage Grinder .Lot Size .
<br /> . ...P�to[..
<br /> V!fatef. PPIy,;Publk.r ism and name',... .._........ ..........�........_.......
<br /> Character of sail,to a depth of 3 feeti Sand�� Silt❑ Gay [ Peat© Sandy Loam © Clay Loom© f
<br /> 4 hiarc A Adobe Fill Mc+mai ........If.yes.type..... r. l
<br /> (Plot plan, showing size of lot r location., of system in. relation.to-wells, buildings, etc, must be placed onreverse side.}
<br /> tY w -. a
<br /> NW INSTALLATION 1(No:septic<ton or'aeepgge'pit Permitted if public sewer is available within 200
<br /> PCAGE,:Tf2EATMENI` SI?PTICTAIVK�:]; Size.......................... Liqud Depth tN
<br /> j] ai
<br /> Cppacity` ty,. Type Y.....:. _ aterial__. o.. Compartmer>ts .,_:1 .� i
<br /> k ,..
<br /> a- 1)tstancelto nearest= Well. ..............Foundatr ,..,• .Prop.
<br /> J n _ o
<br /> n .. o line...........
<br /> Total Length ACHING LINEu:„`I.']: No of Linea ,... LengtF= o each line.............. gt
<br /> ,
<br /> .. '-
<br /> ' 'D' Box............Type;filter Material .. Depth F' er Material
<br /> . -
<br /> y Distance to nearest:'Well Foundation _. petty
<br /> ... ... Pro Line
<br /> Rock Filled Yes No
<br /> �, {�SEEPAGE:PIT .j, =.Depth' ,�x ..��.,...,,... Diameter .... ...._-._ Number .... ............... O ;�.
<br /> ,y � .y. ._..'��,.. it ................. a ............. ...
<br /> 1' ..- Water"Table'.#3epth Rock 'z _ r.
<br /> ►'. .............. .... •--....... ....
<br /> i}istance-to nearest:,Well . _ dation• Fo Pro _
<br /> p:-Line
<br /> . .. M ;.
<br /> . r'
<br /> APAlEADDITION(Priv:Sanitation Permit ....... ..,•._.....---•-• e
<br /> °Septic Tank.IS rfy Requirements) :,,,,- ._ .... pat ..1
<br /> 4 DisposoE Frelpecify Requiroments} .../QD.'_,�[: _.� 17•�lT•--._ /t!!C �...?Tl -_
<br /> __--, 'ys.� ........... ..........r ...........,..........._...._._.......-__..._._ .. - y L
<br /> 77 r
<br /> ,' ..................... ..,. •___'_..«..t .
<br /> ....�............... .L..i._ .,..
<br /> .,(Draw existing and required addition on reverse side)
<br /> _ ,
<br /> I'herebyr'cert�er5:that 1'have prepared this application and that the work will be done in accordance with Sart Joaquin
<br /> oangr?Ordlnpncos, Statr Laws,'anclAvlds and'Regulations of the San Jaoqu'.n Local Health Distil .Herne owner or iioen-
<br /> sod agents signature.certifies th Wfellowing. _ '
<br /> ` •-'licertifr<tlwt in'!hi pek"ance'of-th work'for which this permit is issued, 1 shall not employ any poison in su- manner`
<br /> asro be orr!*subjnct to'.1►; man's Compensation_laws.!of California." µ
<br /> Signed” t ' ....t ....... -. .....,.Owner
<br /> 8 Jfl other+than w
<br /> FG RT
<br /> R DEKA MENT USE [NIi'
<br /> / w
<br /> �. APPLICATION ACCEPTED: By.�, .............,...... .... ..... ... DATE.�!... DATE 2 .�
<br /> BUILDING PERMIT"ISSUED' . :....... .... .. ,..,:..... ..... _.._..... DA ,' } .:,
<br /> w
<br /> :ADDITIONAL COMMENTS`,
<br /> ...+f. :+f" �,a .•; Dote .... �.`.G• ( �~?
<br /> Final1lnspe t �M . ., ...,, ....
<br /> SAN JOAQUIN :[CAL HEALTH DISTRICT.
<br /> E:H,9 1=`68 Rev.5M }
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