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<br /> tOR OFFICE 017, A t
<br /> APPLICATION FOR SANITATION PERMIT
<br /> Permit No. 7
<br /> __ . (Complete In Tdp!icotsl e
<br /> .._ _. . . Date 1ss1,t'd
<br /> _... . . . . . ... This Permit Expires I Year From btsm Issued 'y
<br /> Applicotiod is he,er:v mad�o o the San Joaquin Local Health Distrix for a permit to Construct and install the rook herein
<br /> described. This application Is made In compliance with County Ordinance No. 544 and existing avios and R�syulatlons,
<br /> .!OB ADi.R.'S$/LC CA.TIOIv' I +
<br /> C70
<br /> JOB f! CT' _t-eq .L..cN.J`':U-a- - rtQubCENSUS TRACT "
<br /> Cwne,'s Name ��✓'y-� •-_- - /�� O.C. -""-4� _ '�+..-D Q ..Phone ..
<br /> : Address a , �•aa- 5.� -/... .�.._ . . .. ..City v' N•aGo .. ....... . .. ...
<br /> rll <
<br /> y Vic._ . • . .
<br /> Corkccrtor s!va•ne C:�+ta.P.a! _.� <r. Q.. s °Alcenso aF ./�ar� '�Phwte . . .
<br /> instalioticn wilt serve: ResidenC ❑Apartment Hrrtse0 Commercial RpOroller Coart Cjj -
<br /> MaW []Otner ✓-Vtrvf�y.`I.. .._4G+�{,Y.,.sa_ '.
<br /> Numbe. of !;Aag units: . Number of bedilaornt rbage Gfla!der .. Lor Slis . ............ _. ... ... ,,-
<br /> I +5 Water Supply: Public System and Dame . ..... ... .. .__. . .. ......Privote Cl
<br /> Charocter of soil to a depth cf 3 feet: Sand o Silt❑ Clay [I ,'eat 0 Sandy Loom 0 Clay Loam L3r"` "1
<br /> Hardpan C] Adobe❑ Fill Mu4rinl ...... ..... If yes,
<br /> Al
<br /> i1slot plan, showing.eiye a: lot,.!ocafia/i of syrtem in relation to wdl-_ buildings, etc vmust-be placed. eA reverse slde 7
<br /> NEW INSTAO Vent° ; {ho septic tank or seepsge pit permitted if public sewer is ovallabin wid,%n 200 feet,l
<br /> PACKAGE:TREA..f9EN7 [ I SERT!C.TANf:[ ] Siza ............. ....... ..,. liquid Depth . ... ...
<br /> Capcc!4y Type .. .... .. RYaterial . ......_. No. Compartments
<br /> Distarxs to nearest: Well ._. . Fcunr;aslon .. ._ ... ...__..._ Prop. Lino
<br /> LEACHING UNE ! i No. of Lines .. _, Lengti: of each L'nu _.. ._. Total Length ...
<br /> 'D• Baa Type.Filter Mate•iel --___..Dtpth Filter A1ateriol . ... . ..__..... .. _. .._...., "'
<br /> Distanec to near st, 'Well .'. F�undatien .. . .. _.: Property Lina, )
<br /> r SEEPAGE PIT I i Depth .. iliumeter ............: Nombar _._. ..._.... Rock Filled 'fen ❑ No [
<br /> Water Table Depth .....:._ ... ff tk SGe .......... _.. ..
<br /> Cistance to nearest: Well ... .... .....Fwndatlon . .. . . . ... 9rp. +
<br /> 1,111PALVADDITION[P,ev. Sanitation Permit# ........ ....._.... ........ . .......: Dote . .. ................._ . .. _.! 71
<br /> r Septic ank (Specify ke iviiementsi ...., . ... ...... .. .. - ... . Y
<br /> ar U s
<br /> Vol Field S�-4_ _� ._ � -r
<br /> l aq menty)
<br /> s.. p .. .
<br /> f.0.
<br /> i (Mow existing and requirai odditron on reverse side;
<br /> kt:ntby c,nsify thn I tic"yreparsd this appYiru!ion and that C,v s:,Mrk efll be dorm In aetordanee with San Jeaqu i :
<br /> 9, Caur,ty OrdE nnCes to km.", and Rules ana: Rzguiatiens of the Son Jaacuin Lied Health Livt,!m Horne owner w 1!cew '}
<br /> r sed agsrnts i nnature �Srpes the Co;lowings -
<br /> } ^I terrify tf to ri• wrd:rv:s,a,is a- the work fcr whlLh ihis perrt i s ,s:t'cv, 1 >he:ll A01 1mPi07 any Parson in suth ntarurer
<br /> -
<br /> or to bocemo su!.tect to vy.rkr,*an i; cemprneoflan laws of OsI!f rrit-.
<br /> Sinned ._. . _. . .. .-_. . ..... ........... C.
<br /> rne:
<br /> ��fl
<br /> (!f mher!hnn ..weed ... . .
<br /> _P01 DEeARTIAEHT USE t'NL E
<br /> f .. DATE. P
<br /> APPL " ,iCN ACC6 tED 9Y f ss../ :... _._.. . .. �-
<br /> BU!LD.I IG `+ 'Rr31T SSUED . .. ..._ .... _. .DATE ....
<br /> ADDMONA! COWFAENTS ... . .. •••
<br /> ... .... _.. . _. . .._ __ ._ .... . .......
<br /> Final lnsp,nrt:u:: Ali ....... . ... . .. ..... _ . ... ...........DateJ�/ ' 7"off
<br /> SAN JOAQ1,IIN LOCAL HF ATH rISTRICT !
<br /> �{ E. H 13 241 C.® Rev. eM 7/723 H f d
<br /> _i '�?.ly 4Y';'>,d:•�ca'a,7iFvsa a.•r_-,i'-rib.,... c, .x`h:..,.d.��«"+�,{'�. va _, .. vSaw.Ji'4: ,. a ' r �+,
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