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FOR OFFICE UjSEt APPLICATION FOR SANITATION PERMIT Permit No. <br /> .... . .. (Cornplbko,in Tripljcptel Date issued <br /> ................ <br /> .... ......... .......................... This Permit Expires I Year Fro;a Ddt*Issued <br /> work herein <br /> construct and in the <br /> -------------- -----------*------- to P stall Regulationst <br /> n Local Health,DiJri�t for a permit n Rules and <br /> ...... is hereby made to the Son Joaqui 0. 549 and exist" <br /> Application ode in compliance with County Ordinance N i&-so...... <br /> described.This application is rn ----------- -- -----------CENSUS TRACT .. . ......... <br /> -217 1 <br /> .7 ...phone ......... ................. <br /> _. I F---R- 011 1.....- <br /> JOB ADDRESS/LOCATIO1`j ----------- - 4-1 ................. <br /> W)".1arn--------VAf4--__ .................................... <br /> Owner's Name .....R -- --------- <br /> city <br /> ... Phone ----------------------------- <br /> Address ----- ..... ........... # ......! <br /> ------ Commercial C]Traiter Court <br /> Contractor's Name ------- ouseo <br /> Installation will serve: Residence [,Apartment H . . . ....... <br /> MotelE3 ...-------------------- ........ .......... <br /> -nd.r <br /> Lot Size <br /> GO .........Private.gw_� <br /> Number of living units:..----t----- Number of bedrooms ............... ------- <br /> .............. I <br /> Water Supply: Public System and n.0me.... ------- peat[3 Sandy Loom Cjay�Lticim <br /> :6t- Sand 0 Silt 0 e .... <br /> Character afsoil to a depth of 3A - I ../ . If yes,tyP <br /> Adobe 0 Fill Material _V . If yes,tyP <br /> ../ .a <br /> ._VO <br /> /'Hardpan Ado <br /> be placed reverse side.) <br /> in relation to wells, buildings, etc. must <br /> --sho\�4n'6 size of 10t,_10cl:ttion at system within 200 feetA\i <br /> (plot plan, it permitted if,public sewer is civailabl <br /> septic b eePQ99 -P Liquid i . uid Depth ............... <br /> NEW INSTALLATION: (Nb so Size.1­4_1...I----­---------------------­ <br /> IVT41N Compartments L-:3.............. <br /> PACKAGE TREATMENT I-) Sep, Material---------- N <br /> % C�4�;ty ...... ... .....�Type -------------------- ., . ,- Prop. Line --------------------- <br /> I f .....Foundation --------- ---c----- <br /> bistance to ne& ------ ....... ............. I I' "I __............ <br /> 0". Z ch I- Total Leiidth";�ff *..... <br /> Le6gi f eci line--......-------------------­ ------ <br /> . N. / <br /> LEACHING UNte" No. of Lines ....... ............. .. ........Depth Filter M eirial ............ <br /> I T pe Filter Materico............. <br /> D' Box ...... Property Line .................. <br /> foundation ------------------ ---- -�- % No 0 <br /> Distance to necire t: Well .......... Rock Filled tesfer .....zTf_,�Aumber <br /> ........... .."Dii ....... <br /> Depth ------ <br /> SEEPAGE PIT I_......Rock Size`................. .............. <br /> ter.j'ta�,Ile. De --------------- j_ Ule ..... . <br /> Wu ---------------- .........I... Prop <br /> }.-.... .Foundation -­ - <br /> Dis jDat's ............................11 <br /> ..........j. .............. I C.& <br /> W ...IQ. <br /> 6 <br /> REPAIR,/IAID)DITION'lPrev.'ISciniiation%P�errnit# ....... <br /> T_ <br /> Y........ ------ <br /> 10 ........ <br /> ............ <br /> Sept! Tank (Specify•Rvqi,iir�.emen .....­ M. . _ ... <br /> Disposal field 1 1.pecif.y Requirementsio <br /> ...... .... <br /> Disp ...I------ <br /> ............ <br /> .. <br /> - ._1.i2_..-.. _RI ....... . <br /> ........... <br /> . <br /> (Draw existing and r ..... . addition <br /> -----o--n r s..e...s.d <br /> e <br /> -ffiinlii work wIll be done in accordance with Son Joaclul" <br /> 01WIi aiid a Health District. Home ownWror licen- <br /> 3y certify th t I have, Prepared this I I <br /> I herel I I�vs, and Rules and Regulations of the San Joaquin Local �:. <br /> County Ordinance% SiatF La f ollowin, is issued, I sholl no, employ any person in such marine <br /> sed agents signature certifies the kh, : ch this permit <br /> "I certify h in the rMance of --ark for f California." <br /> pensation WS 0 <br /> as I Owner <br /> i'y bi <br /> e.b.,. Walkman's <br /> . . ................................ <br /> Signed j2jo, Title---------------------------------- J-v <br /> BY ------------------'x' "7t ..... ....... <br /> .pf,oth than owner) <br /> FOR DEPARTMENT' USE ONLY <br /> 7tpp� DATE .-�.. ..... <br /> ------------ <br /> Ch his p <br /> WS ofca. <br /> IONLY <br /> 104- <br /> DATE <br /> ---- DATE_.`.-: --f -------- <br /> ............ <br /> APPLICATION �CcEPTE15 Bli ............. <br /> . . ....... .............. <br /> BUILIBUILDING PERMIT ISSUE, ......._fs ........... <br /> ....... ......................... ---------- <br /> TjONA-L-COMMEN J ............... <br /> ADDI <br /> .............. <br /> __---------------- ........... .. .......... _--- ��;;/ -L. <br /> ....................... ------------- ............. <br /> .... .. ..... ..... ----------- Date ...�T....... <br /> .............................. <br /> Final ins ion . ...... ......... ....... <br /> SAN JOAQUIN LOC-XL HEATH DISTRICT <br /> CAA <br />