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FOR OFFICE USE: <br /> .................................... -------- APPLICATION FOR SANITATION PERMIT OFFICE USE: <br /> (Complete in Triplicate) Permit No......772�77__F <br /> ......................................................... --- _X9 <br /> ................................... e .. <br /> .............. s d... 7 <br /> This Pen-hit ExPiires I Year From Date Issuid 6�e-Issued.n?-­ <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work.herein described. <br /> This application is made in compliance with County Ordinonc No.1549,and existing Rules and Regulations: <br /> JOB ADI)RtSSAOCATION......J�� <br /> . .. . ......................... .................................CENSUS TRACT............ .. <br /> -- ------------ <br /> Owner's Nar6e -------I <br /> ..... ............... ... .... .. ......... <br /> -3 ....... Phont. .......... <br /> Ad' o <br /> dress............." <br /> ... .... ................ .....City., <br /> ...............Zip.......... ......... <br /> -tors Name..:. <br /> ContraL <br /> 70_:./....f....... L <br /> - -----------�! <br /> ... ... --- one <br /> 6t!O5 willser,ve: Re ide ...................... <br /> Install <br /> Residence, ptirtmerit House <br /> . : Commercj.al-'o >Traifer Court'E) <br /> Motel oOthe�.j........ 49 - f <br /> ............ .......... .......... <br /> Number-bf <br /> ................. Ms:�t- -�.".Garbage Grinder............Lot Size-1 <br /> Wcter'Sopply: Public System and-narrie........:.... % Q_^ I I <br /> ----------- - <br /> .............------ ........... ...... <br /> Character of soil to a depth Of-31ee --------- I ------------Private Ar- <br /> t. Sand El 'Silt 13 Cloy Peat 0 .,Sandy Lobm [] Clay Loom <br /> -R-araP—an ❑ <br /> at4ri <br /> If yes,typea-e- ......... <br /> (1`18tplan, showing size of lot, Iocojj;0n 0 <br /> I �. f system in relatMn to welli, buildings,etc.m <br /> NEW INSTALL'ATJON: t must be placed on reverse,side.) <br /> .(No�septjc`ank�or seepage ii" <br /> P if public sewer'is available able.within 260 fee't,) <br /> PACKAGE TRE SEPTIC C TAN I I <br /> ...--•------••---•._:'.:.. <br /> TREATMENT K1t I size..... <br /> ------ 4. . UqA 'Depth._ ......... ......U, <br /> Capoci <br /> _..r_....._Type _it Ma Co' <br /> .......... ......... No. m tmehts--.-.. <br /> par <br /> -- -------- .................... <br /> 'Distancetonecrest.. Well,,....... <br /> LEACHINE�L NE' ------­------------------- dation..? ......... ..Prop..Line............................+ <br /> No, of Lines-.... P I , f <br /> =,�­­_�-ef._'h of each line.::.� ' <br /> _m4—. ..... Length -------�­­------ Total Length.----,..:...............•----------•-- <br /> ............... <br /> -------------- <br /> Ox...:-----:..Type Filter�Aa4ri I' <br /> 'a -------------_--*� <br /> ,I .... ....Depth,Filter Material.................... <br /> DistanceWell. <br /> . . ......................... ................. <br /> to nearest: Well.......... ...... n <br /> - I I. . . ... ­­ I.............O�u datioh............ Property Line.',------------ <br /> 5EEPAG" E_ �I_ . --i- - .. . ..I ..--- - f ­- + � .................. <br /> T A epth-_;•............Diameter._� .... -----------Number...*...............I <br /> Rock Filled Yes No <br /> VV;4r--T0-UemP-e-#--'tW.. <br /> j ---------------------------;---------- --.Rock Size....... <br /> I I; . . ............ ................... <br /> -.iDistan*ice'to nearest: <br /> =:.::._... .......... ................... . <br /> Found' <br /> ..) ---- ------ ---------Prop. Line'.:-.-------------- <br /> REPAIR7-ADDITION (Prev..S6nifotion 4rmli ------------ <br /> - -----------_----_ ...... <br /> Septic'T8nk (Specify'ReclOire <br /> ......'...........- i <br /> : .. ­ ----------- ----- <br /> -------.----.--.-.-.Dispo9Field Requirem6nts)_ --------.-.-.--.--.-.-.--.-- <br /> .-...... . <br /> .....-.-.-.-.-.-.-.-.-.-.-.-.-..-. <br /> --1-11 ------ -..-.--..--.. <br /> -- -- -- - <br /> -A- <br /> --- . <br /> y,a <br /> ............. --- - ...... .............. <br /> ........... <br /> ................ .............. ............... ................... ....... <br /> ---------------------- <br /> ------------------­------- <br /> ..........row existing and ............. .................... ...... <br /> required addition on reverse side) ...... <br /> I he'reby:ceM' fy that? have prepared this application and that the *work,will be, done in accordance with Son,Joaquin Coufity <br /> Ordinances,), State Laws., and Rules and Regulations of the Son Joaquin <br /> siaAcIture;reilifies the foli-ow"in's; Health District, Name owner or licensed,agents <br /> Certify--that'in the ptirfainidKce af'.the work foi7%4hich thii pernift m ny person in such manner*I as <br /> .to become ;uNeo, to War issued not e' pl'6y id' <br /> R s 6mPimsciflon law:$ of California." <br /> Signed- 7701 7 <br /> ........... .-,Owner <br /> ............... <br /> ----------------- <br /> .....................T. <br /> By. itle... <br /> an owner) <br /> ............. <br /> 11�,D;her th - <br /> --------------------------------------- <br /> -_ <br /> FOR DEPARTMENT USE ONLY: <br /> APPLICXT"JON ACCEPTED� <br /> B <br /> y <br /> ....... <br /> ... . ... ........ ......................... .. .........................DIVISION F LAND NUMBER........ <br /> AD�PITI , AL COMMENTS. ....................... .........DATE................................ <br /> --- ----------------------­A.,... yr.. <br /> r.. <br /> ---------------- <br /> ------------------------------- <br /> 7.......... .... ........ ---- .. <br /> ................. <br /> ..................................... -------- <br /> -------------------------------------------------- ------------ <br /> ....................................T......... <br /> Final•Inspection b%/.." .. .... .......------------­--­-­----- <br /> --------- ---- <br /> ........... ------- ---------- ...... <br /> EH 13 24 ...... > <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2t EV.7176 3M <br />