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OFFICEFOR <br /> USE: ~��~ <br /> APP� �U �*�����X� SANITATION PERMIT <br />| A ' (Cwrmp�«ein�6py�w�) `t Permit <br /> ` <br /> --------------- This Permit Expires 1. Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health D'igtri&Lfor a per.h�it to constry nd inst 11 the work herein <br /> described. This application is made in complicfAce with Counti'Ordinance-No._549 a exi.sti and Regulations: <br /> JOB ADDRESS/LdC__ATI6_N <br /> Contractor's Nal me ... -.Licen—se <br /> Installation will serve; -- -^ ucs/nnmma�� *pon�en, n�uxo�J comme�io| E]TroUeiCmv,f �� <br /> ~ ' <br />' * <br /> Motel E]Other ' <br /> Number of | <br /> | <br />� - ' ����-- - ------- '---'-T--'-��^ Grinder^ *^�`«� "~' °�=^ ' <br /> Vyo��, Sv p�. Pu�| 6 1 <br /> C6o,a&e,of mzi| t}a depth of feet:� Sand! ' Cloy [] �Peot 0 Sandy' ' ^x ` Ck,v� <br /> ' ' -- ' <br /> �---� Hardpan [] Adobe,[:] U ° . <br /> (Plot/plan, sh8wing size of lot, lacation of system iri relation to- wells, building;, etc. must be placed on reverse si de.) <br /> NEW INSTALLATION-,(Nq_septic tank or <br /> seepagepit.permitted' i~~public sevyer is available <br /> --- --' --~—'~~'" <br /> PACKAGE'TREATMENT. `| ] `SEPTkC7ANK:[) <br /> -i`__- _Siz�-' ` �~'� Liquid Depth ------------------------- <br /> Capacity <br /> '—'---`'- <br /> Cbpoch/ ,---.=-.. <br /> ` <br /> Type ----_--' y�oA»�oL------.. No C�mpu�n*�n+ --_-.-'^'�-' =�| <br /> Digonco to nearest. Well <br /> - .\,+-'... -�-`�. � ^ uon ' ' � »p. o . <br /> v '-'�------- <br /> LEACHING <br /> -- <br /> LEACH|NG LINE No. of Lines ---- --_ - - ( --_'--- Total ionmt6 ----------- --- <br /> .D. . <br /> =�^ <br /> Dox ---- Type �Ko, N��eru1 --'_---'Dep�h ��o, ��o�erio1 -----.---.--1_--�'-- <br /> Distane to nearest: Well . -- Foundq Foundation -----.-.. Property Line <br /> -----'_�_ <br /> ----- <br /> SEEPAGE PIT Depth -------------- ----- Diameter -----.. Number ----------- Rork F;Uo6 Yex [] No C] ' <br /> Water Table Depth ------------------------------------------------Rock Size ----.-_-_'_' <br /> oistonce to nearest: Well --'_`---------------------------- -------------------- Prop Lina .............. <br /> _- �-'_' / <br /> (Prev. Son hation:Pmnnk# -------- ----------------------------------- Date __---_-_----) <br /> SepticTonk (SpocifyRequirements)v]~,� <br /> I. <br /> um (Specify ~ <br /> r----'' -------'—'—«''—^� ->-'- <br /> --�-----------'-------'-_---.,_''-- <br /> -_------------- -c-.--'__—___________-___ ---'-- - ----' ' `--'D,ovmx��ngon6n,quire6md6Nonmn reverse d� - � <br /> ' <br /> I hereby certify ��U have prepared this application and that the work will be done in accordanceV� San ~ ` ^ <br /> County Ordinances, $wmhm Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner -�-�- '- <br /> yed agenu^ signature mmm� <br /> � es the following: <br /> `-- � <br /> "Icertify that [nthe performance *f the work for which this permit |wissued, Ishall not employ any person Ammw ' mmm'mwv ' <br /> as to become subject to Workman's Cw -'� ^^ � <br /> Signedwner <br /> ��������� ^ <br /> FOR DEPARTMENT USE' ONLY <br /> __--.--- <br /> ---�-_--_`--_--_v_--- ._-'- - ' -_--.__ <br /> - -. <br /> - ----- <br /> ------------------------------ <br /> -' <br /> -'--'—'--' ----------' -' <br /> -'--'—'--' -'--�no||nspmc |m, — --''--- ------ <br /> ----------- <br /> '- <br /> ' <br /> | <br /> ------'---'------'^ -- <br /> SAN JDAQUUN LOCAL HEALTH DISTRICT <br /> E. HL 9 1'\58 Rev. 5kA ��` <br />