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' FOR OFFICE USEAPPLICATION FOP. SANITATION PERMIT PermitNo4 <br /> , � <br /> . ^ NCmmpJwte1mT�p�*a�0 <br /> Dmho |uso�� <br /> ' iExpires 1 YFwm,wDate issued � <br /> ------------------------ <br /> --------------- <br /> work herein <br /> Son Joaquin Local Health District for a permit to construct and jinstall the <br /> Application is hereby made to the <br /> described. This application is made in compliance with County Ordinance No. 549 and existingRuies and Regulations! <br /> JOB ADDRESS/LOCATION ---- --.5z -0 Y--- ---11----——- -----------------------------------CENSUS,TRACT <br /> lu- .. . ..............A-- t - 6 <br /> Owner's Name --------------X, --- - I k <br /> Installation will serve: ResidenceXApartment Housef:] Commerc [I. <br /> Number of living units------ Private El <br /> Sand'E] Silt Clay E] Pea Sandy Loom F <br /> Character of soi I to a depth of 3 feet: <br /> ' pan(Plot plan, showing size ~ <br /> mus; be placed on reverse side.) <br /> ` | � <br /> sewer is available within <br /> | m�°" "~°,�^^�,,~~, .�._ _ 200 feetJ <br /> , <br /> � '"C~~`~E TREATMENT ^ ~ -------------------------------------- <br /> ;I I Material No. hCompartments --.--'''�'- W� <br /> ' ,o nearest:, '--— ' ' '_---_'roonnann" ---._ <br /> -' Prop. -_- <br /> Distance r <br /> Ii ----------------------------- <br /> LEACHING <br /> - Total ienu�� -- <br /> LEACM|mGumE of ""es - �_motd, | <br /> A�^ <br /> � <br /> � <br /> � yp <br /> �u ,,=" --'-^-'-- ' — ' <br /> j. _ Filled NO 0 <br /> -_-_-__- . ^ <br /> � � --�,_4m=ll` "�.6ohun -i Prop. Unm ---_-----' <br /> Distonceonearest: Well ----------------- <br /> � <br /> � --,'- Tank (Specify Requirements) _________-- <br /> Disposal Field (Specify "ey"" ."""~ ----_'----- , <br /> ~�`� '—i_-.-___--_---'^ '--''-- <br /> ^ '-—.—-'--_---- _ ' — ''i -' <br /> --. <br /> --..--- .— <br /> ___—.--'---'-------- <br /> '—�--'—'—'--'---- �onreverse side) <br /> (Draw and required mJ6m� <br /> ! I �� v o�m ~I rk will be d�nmlm accordance with Som Joaquin <br /> I hereby certify that I have prepared this applicationand 0 <br /> County OrdinancestiState Laws', 6nd Rules,cin4 Regulations of the San Joaquin LocallHealth District. Home owner or licen- <br /> sed agents signature certifies th�41lo-wing: Lifson in such manner <br /> t of the work for which this permit is issued, I shall not employ any p <br /> "I certify that in performance. of Cajifotnia.". <br /> Ws- <br /> il ^ ' Ovvnmr <br /> . <br /> Signed ---'---' <br /> n ovMeirl <br /> . ~ 0OR rDEPARTMENT USE ONLY <br /> ^ / l <br /> APPLICATION ACCEPTED BY '�'>—'-��--'---'---'—'—'— <br /> V -DATE ` ----------------------------- <br /> BUILDING � <br /> PERNUT ISSUED ------------------------------------ _-'----'-'_---'-'�--_ ------ <br /> ADDITIONAL <br /> _ <br /> AOD|Tx]NAL COMMENTS ---.--.—''�.-'---_--�_---'--'��---���''-'--__-.- ' _ ___ _- <br /> . -'---�-----.---__----- - --- <br /> ---_--_'--_�- ��-===,=�.".�__� <br /> .-�________ - -----------�� _____--Do�e -'� <br /> ' Rno| Inspection 6y ---��'�'�---.—'----_---_-_'-'--- 41 <br /> ---- <br /> SAN JOAQUN LOCAL HEALTH DISTRICT ' <br />