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FOR OFFICE USE: <br /> . , APPLICATION FOR SANITATION PERMIT Permit No,. <br /> � (Complete in Triplicate) <br /> ~ i Date Issued — <br /> � xpires Year From Date issued <br /> �� / <br /> " --- <br /> made ` Joaquin Loco Health District for o � to construct and install the .wn,k~h�r�n <br /> Application i h the «/"y"|onc� ^' H^`e�{]ounty Ordinance No. 549 and existing Rules and Regw|o6unw' <br /> described. This application /a moo� m �v".p. with . <br /> '"" "~~~^~~ ^~`~''—' _^'`^ Ph AID <br /> vw= " '`"^'~ -------'~ --' ---'--- - _� ` <br /> A66muo .. ^y«� '--��' ����'�� ��''--'�r��'-----'-'--- Chy '^'~�����''»n��---'-'---------'—'--- | <br /> ' � �� � \ —L�en v� Phone ------------------------------ <br /> Contractor's <br /> ' <br /> [on�o�or'sNome ._^��.c��.����,~~—_—_---'---__----^-- License -__—'—'— —'--'__—'-_ <br /> Y�� ` Co�nne��l []Tnyi|mvCmur �] � <br /> |m�U�� �U �� �dd�� ��A��� ���� ` . � <br /> 8A��n . Other ._' ' <br />� . oxn,n �� —'---'------- <br /> Number of living units-...2 —.. Number of bedrooms ��'--.Qm,6oge Grinder ------------ �� S�e ./�o��.x��n��^'�=-_'—' <br /> _ ` ,��� -----------------------------------Private E] <br /> VVo�r8vpp�. Pv6|hc�ya�,mon� n�me ._=`.^---'�**..-_-_---'_—'---__--_—'— <br /> Character of soi| modepth of 3feet. Sand C1 Si|r(:1 Cloy E] Feat E] Sandy Loom -C] Clay Loom � <br /> Hardpan D A6o6ox Fill Material ------------ Ryes,type---------------------------- . <br /> —����� o� � |� location � �� |n m�un to wells, buildings, etc. must be placed on reverse side.) <br /> (Plot— plan, i|o6 vvkh 2D� fwmt) <br /> NEW INSTALLATION: � ��|c�nk � �� � � p�c �� |s � �ew�n | <br /> � � --. Liquid Depth __---'—'.—_ <br /> r°CTREATMENT [ ] -- '—TANKf~ Sbe--'—' —_-_--.--- Nm. Compartments ._'- --------- <br /> Capacity <br /> _'— <br /> [opochy —�'--.— Type �------------------ Material <br /> Di�once to nearest. v �` ^—`---I --------------------Foundation . .�--'-'' prop' LUne -'- -'�- <br /> LEA[HUNG <br /> |� <br /> UNE [ ] No. of Unau .-------- |�no�� of each line---------------------------- Tw«z Le�o�� �'_'--'—'—'-- <br />/ ^ ''D' Box --_.. Type Filter Material --'_'_--Depth Filter Nkn��io| --'_'-�-_—_—'_-._' <br /> � s� VVmU --------------- <br /> ' t P�ohdpYio� Property Line ------------------------- <br /> I <br /> .—.—.---�-' <br /> Dimonco ����norax� '�—_�—�'---- —�------ <br /> 8EEPAGEP|T [ ] Depth --'..�--.. Diameter _'--'_ Number ----- ---------------------- Rook Filled' Yes C] No 0 <br />! ----------- VVo�n Table Depth -----_--_—'------'-JlockS|za .-_—.—__'._-- <br /> � 0�on,e toneonas� \��( ._.—'�--��-__'-_'-Fovn6oMun .--'-_-_' Prop Line -`,__'—.'— � <br /> ^ Date -- ' <br />\ REPAIR/ADDITION(Pnev Son|�u|onpern`�v� _---_----_--_'-- _'--'-----''-- , <br /> � . --------------------- <br /> Disposal <br /> - � <br />. --------------------------------- <br /> Septic Tank Requirements) .----'---''r. __-- _ ��� <br /> (Specify �� __ � �� ���� '--e--aa- <br /> ------------ - <br /> �-.^�^p'-�*��`' <br /> Diypoao| Field (Specify Requirements) .--'*~�'_—'�_^'��',---v°---~_�^~--~~--'---� <br /> -- ___'—.--_.-----_--_--'---___—'- <br /> . (Drow sting and required addition on- <br /> reverse side) <br /> �l| ~ <br /> | h�� �� that , have � � t6� application` and that the vwrk.vil| be done in accordance with Son Joaquin <br /> County Ordinances, Smxw, Laws, and Rules and Regulationsof the Son Joaquin Local Health District. Home owner or licen. <br /> ' ' <br /> / <br /> sed agents signature certifies the following: <br /> ed. U shall not employ any person in such mmmnmv <br /> ^; certify that in the performance �m� v�r& for which �6;w ���ml� �w �smw <br /> � mm to become mw6�mw� ,m VVm,&mnmn's Cwmpwmoo�wn laws of California." <br /> ' Owner <br /> Signed --------'-------'------------'--' <br /> ~ Tt» ���� <br /> -------------------'—' <br /> 8y ~ ' __.______..�._�_ <br /> -4 <br /> USE ONLY <br /> | <br /> BUILDING PERMIT |SSVEo ---.-~�---------x----'—'------'-------'— � ____________.. <br /> ' <br /> ADDITIONAL COk�N\ENTS -------.—'_-------__--'-------------'—'--'' <br /> ------------------------------------------------ <br /> ! -------'--'------�-----'—'—��----'—'—'-----'------- -- ------- <br /> ----- ---------------------- <br /> ----------' _ . . ' <br /> —'--' <br /> �no| |nopechon6y. _—''— _ Do�e ^7^ ^,/—~'' <br /> ' _ <br /> SAN <br /> JOAQU\N LOCAL HEALTH DISTRICT - <br /> E. l''�ORw� 8N\ <br /> . ~~�~_ <br />