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}I <br /> lilt" <br /> ^r <br /> ]1' <br /> 40R OFFICE US& E <br /> FOR OFFICE <br /> APPLICAVON ,,,V SANITATION PERMIT Perm <br /> L d <br /> it No—,. �'�• r'> 4 <br /> (Complete in Tripiitaft) �u€ <br /> Date€slued <br /> This Permit Expires 1 Year r-rom Date issued <br /> .................................. of?. <br /> Application.is h'ereby:made.to the'Son Joaquin Local Health District for a permit to construct and Instal! the work heroin descrrbeel <br /> This application is made in compliance with County Ordinance No:549 and exr•ting Rules and Regulations kf�..."� ' <br /> W C�f��HT,c Ci ' <br /> __CENSUS'TRA�T La 1 x '. <br /> JOB �ADDRESS�LOCATION 3 s ►�i! <br /> " Phone 3 : <br /> • Ctwner s.Name �rZ. r ..:. - ��r�-ys� t <br /> License <br /> .. Z'i� <br /> Kms' 7—�,q�y <br /> - <br /> r ,cense Pl}ane , q5 , <br /> Contractors Name ! r !illjr r i, t t , <br /> t - House 6Urt ,�!°ir.y J'µ+1. <br /> t, Instails,tron will serve Residence© Apartment He❑ Commercial Q Trailer C <br /> Motel Other _._ s{ 1� t . <br /> © y.L.Garboge Grindw._.._....—Lot Size._....��d <br /> �':Nulmber.of Irving units::.:... .. .... .Number of bedrooms:.. ~ <br /> Y <br /> to <br /> Water Supplyl'Public System and name......... a 1. i } Pri Fa <br /> Character of' to a depth of 3 feet: Sand ❑ - Silt Q 06y4(]' tPeat❑ y Sandy Loam Q Clay Loam <br /> Hardpan.[].:...Adobe " Fill.�'Aaterral;.'.:. _'-1 yes- yP6,�.!_,�.-s,.s:� ...sv>i•csr r ^�""y ��! �;_}1rt.3?i;j:.s <br /> .v m:thrQ Vii;',. <br /> t j(Plo 'p{anj showrngrsixe of lot lace'tion of system, in relCtlbn to Wells bulldings,etc must-be#�faeitdF i re;Yers s'icld] <br /> tl::. , <br /> �€r1�k1 j"IIV5TALLA710N INa septic farrk:or seepage prf permuted rf publrr sewer i�a�ntlable'withtri 20G�feet } �t <br /> # '1'AC4GE TREATMENT [;}] SEPTIC TANK [ ] Slxa ._ t: : Lrq'udDptli� :^ �'I <br /> t t '..Material. _ No Coiripartme <br /> Capacity:' .-::_.: ..:.Type " i #i lag, <br /> st Welt.. Proak Line 3 >#t <br /> r <br /> Distance-to noare Foun aflon u, <br /> .. - .. <br /> ' -" Total <br /> l a•L CWING LINE [7l too of Lines Length of each Irna F g tII t <br /> zllllir" r �' D Box Type F11ter'rMaterial i t7esth Filter Materlal <br /> lili c li l�r :i �' r �!c <br /> t i - `I. ] Distance to nearest.Well. .:Foundation Property}Line} tl z;v <br /> lift ,F"it " -'I ROGki[led-Yes( ; Na <br /> BgPAGl::PIT fie 1 Depth biometer, Number... G A <br /> � . ....: Rock Sits:- ',r a t <br /> W. <br /> Table Depth r; <br /> ! <br /> r Y <br /> ! '�iq I I <br /> " ; Dlstatice to nearest Well.. Foundation ._-. Prop Lrne ?3 tsa > <br /> r ltd AIR/ADDIMN{Prev Sanitation Permir .:. <br /> Date <br /> 3 Sf i °Sa r gft ' <br /> w }'SapticTank,(Spec�fyRequlrements} <br /> e wremertsl.•,.... ..... <br /> '.�Disosal.Field l5peeifyR a _ t r z ilyfy' �1e"trir�'t��i <br /> n 1,4i' t Pit Irl I!� K .......... <br /> j y <br /> .__. E <br /> t f <br /> l <br /> {Draw,existing and required addition on reverse side} <br /> ! I 1 I ry _ '• l sni{+�1 F infill t. <br /> i.;harob�carfify t3iat I have i4parrd this application and That the work:velli b`s'done In accordanea Mrith 5af�}:�iotlqul Cdd <br /> �rdinpneosn Shsta;La rs andrlRutes and Regulations of fhe San Joaquinllocal Health Drstrlet; Home owner e !(een#}t jog <br /> llgpaFuro eerHfresthe following i h , E }}� } <br /> girl O <br /> ='I terfiF�;lfhat in.`ih�perFormanae of the woriic for wh h this permit 1s issued, 1'sh611 not employ any per:ar► lrtiweh rrra"ienet <br /> Pier!O belOrSle lull t to'i'�V man^s lip ation I of Califamia <br /> nor i <br /> BY r ......,. Title.:: „ �i <br /> ...... <br /> r 3 <br /> e <br /> _S <br /> (If other than ownerr l ,a a <br /> r FOR.DEPART Nt USE ONLY: <br /> ........ <br /> APPLICATION ACCEPTED.By_ <br /> ......... ........................:....:................ DATE ............. <br /> DIVISION OF LAND NUMBER ....:... ....:.............• .................... <br /> ADDITIONAL COMMENTS <br /> ].f <br /> ....................... w41rti <br /> 3 { ... li <br /> >rnal inspection by. G GGr <br /> Date, <br /> ` err 13 s. : .. SAN JGAQUIN LOCAL HEALTH DISTRICT <br /> las 21677 Ker 7/76 2µ'.L <br /> �i�'-t4 -r!,. ,.r �..,�_ .:w...�,,.w . w,ur►.Fe..+-.^^^.M«,�1.� we:Arh:.'4iiCtjt"r� <br /> w <br /> ,`i ' ':r {' :Is '!`� ', I •li: r 4{I. . <br />