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rr <br /> n %001 ... <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ` Permit No. ..7_2.:..lL.. <br /> (Co.mplete in Triplicate) <br /> ..�.:..'..`.:..�L <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> A•pplicet.on is herei,y made to the San Joaquin Le-.:al Health District for a permit to construct and Install the work heireir <br /> described. This aoplicotion is made•;n cornp!:once with Countv Ordinance No. 549 and axisting Rules and Regulations- <br /> JOBr •. .... CENSUS TRACT ........... . .. .. <br /> ADDRESS/LOCATION %y9.>. . ..1=...._.H <br /> C..NTR <br /> Owner's Name ...KE 4L......... ................. ... . .........._ ..... .... Phone ................................... <br /> Address .Zf��..`.a�. .L�l�rt.�... t1 E. ...... ........... city . F�;ourinj. .......................... <br /> Contractor's Name(J;'vDER6R00/fVD (�:rl..Lf. .T.?..E.�...... .... ..License # .... . ....... . Phone ......... .................... <br /> z <br /> Installation will serve:' <br /> /_C- <br /> Res;d ncez�Apartment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other ................. .. ........ ..... .. .. <br /> Number of !;.,;ng units: / Number of bedrooms ......Garbage Grinder s lot Size A 4 RAE!9C.E............ <br /> Water Supply: Public System and name ................ ..Private <br /> Character of so:l to a depth of 3 feet: Sand ❑ SilSilt Q Clay [] Peat[] Sandy Loom ❑ Clay Loam.e- ­� <br /> Horupon�Adobe [] Fill Matarial 11.1 if yes,type ........ . . .... . <br /> [Plot plan. showir•g size of lot, location of sys.cm in relation to wells, buildings, etc. must be placed on reverse side.) <br /> r NEW INSTALLATION:: !No septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT_ [ ] SEPTIC TANK[ J Size .. ... ...... Liquid Depth . . . .... ........... <br /> Capacity Type Material. No. Compa.lment: . ... ............ <br /> Distance to nearest: Well .. ... .. ...Foundation .. .. Prop. Line . ................... `1► <br /> LEACHING LINE [ J No. of lines Length of each line 13,tai length ............... <br /> U' Box Typ Filter Material ....Depth Filter Materia) <br /> j Distance to nearest: Jell Foundation Property Line <br /> SEEPAGE PIT t Depth Diameter Numbe• Rock Filled Yes ❑ No ❑ <br /> --- <br /> Water Table Uepfih Rock Size <br /> Diston•s> to ne^.rust: I Fn.indot;jn Prop. line .... ................. <br /> R`?AIR ADDITION iPrev. Sanitation Permit#I Do 1 <br /> Septic conk ISpecifv Recq•-jne�n*,entsl - ... . .. . ...... <br /> Dir,pcsoi F:cid tSt;nc.fy Requ:rcrnentsl /1,•F.ti+ .) <br /> . Fi-, IC. <br /> �.. T16HT •=-1 N E. TC 5X .6 X /% E_Pio-)6 IC / T' <br /> +.Dross e.xisiing oncd rogv:red ar.ldicion on •r:.vcrse side) <br /> 1 hereby cortify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin <br /> Covnty Ordinances, State Laws, and Rules and Regulations of the Snn Joaquin U tot Health District. Home owner or licen- <br /> sed oycnts s,g aivrc c.rtifies the following: <br /> "I certify tha in che�{s rformance df the work for which this permit is isvied, I shall not employ any person in such manner <br /> as to become subject VYorkma�i Compensation laws of Colifornie." <br /> i / <br /> S:aneri .0 C -a• �..�(,°" _ c:' G.C Ciw,rc: <br /> By r utter. r° .•, / Y. {; C <br /> rOR DEPART;+JEP4T USE ONLY <br /> ^pliC' . :�_ -S,• r� DATE 2 <' TL-- <br /> /7 _ <br /> r . <br /> I <br />