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As.", r, ,� s k� ,_ ✓ ._— ... ., _ latex;. <br /> " 9 FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERf;IT <br /> . . <br /> ..€: <br /> (Complete In 7dplicaN) <br /> ................. <br /> This PemJf Exolros 1 Year From Date lune=' Dore irsved,3.�25'74! <br /> ` - ttPlicAori is tl*reby mud*to the San Joaquin Local Health Dirt foh,a permit to construct and Instaii the work herein '>f <br /> g ,: _• a'bokThis'application Is made In compliance with County Ordinance No. 549 and ex4ting Rules and Regulotklner <br /> 2` °$ <br /> JOB 4,DDPESSAOC +ION. .. ��I`(A�sk.iCO.c2- Cir .ct.Fi�-CENSl15 TRACT - ¢.k <br /> Sr , <br /> n f OwytrTe'Name VS.NA f Mc�L4 S,f pwr aw,one r'S � j <br /> Add „,d .. T.5....................................... City:. <br /> ' ContCommercial <br /> I, ..Re'deocetGgAP rtme Hou <br /> t ut7 alLicense <br /> I ❑'Trc• Countef'j. Phone <br /> 'r Motel❑Other.... ..................... .. ...... ..... <br /> bet o{'Iivipp um tY_.(........ Number of bedrooms Garbage Grinder tat'size � <br /> + Wow &ipp ;0 .,bi ia`£ryetem and name ........ ................. ......... .._.. ...... .... Private <br /> } 'Char ester or e'ti�l fo udepfh of 3 feeR Sond o Silt❑ Clay C] Fear Peat❑ Sar Loam ❑ Claam i <br /> S y teaI <br /> Hardpan Adobe ❑ Fill Material ...... It yes,type s" i• sy. �' <br /> s f? zPlca plan, ah.aw :size of lot, location of system in relation to wells, buildings, itc. •must,be`placed qt reverse s10.1r <br /> z `fry A NtW NSTAYLA 11,40 septic�tank or seepage pit permitted if public sewer Is ailable within <br /> Ic fiN} d <=V <br /> rl A <br /> 1W <br /> J I'ACKAt3E. TStFJCf/y� „.SEPTIC TANK Z ) ,Size........ .. tquld,"LDepth <br /> • ,.b ... Ty;e .................... Material No Co.iptzrfinenh <br /> . 'Oiftance- t0 haoresh Well ...................... Fovndatie .Prop UM. <br /> K e ...,. <br /> Nu. of Lines .... Length of each line ......... . ..... ..: TotalAsingtr ..... <br /> i Filter Material Depth Filt r MoNrlal - <br /> ' k ` .-Well ` Foundation 1FYopeAy�tkn <br /> ..... .._ .................. <br /> Depth c nearest ,Diameter ................ Number :.... i Fillitl Yet ❑ Not�� <br /> D Box . T <br /> u , c Water Table Dep?h.. .Rock Size .: <br /> '+r �rv�t° <br /> Distance to nearest, Well ......................................- Foundation ;'- ProLlne .. <br /> RRAIR/ADDITION(Prev. Sanitation Perri>It t . Dote <br /> Septic Tank (S�teci fy Requirements}p ....._. - <br /> ..::.. '. <br /> r <br /> Disposal Field (Specify Requirements) ...... <br /> ... .. .�. Y.: .. ?, r�r v <br /> ..... <br /> c „. ... (Draw existing and requ.red addition on revere <br /> hereby certify that'4 have prepared this appileation wd that the work will'ba , ane in aecadanp Zeftit fan' esjirin' <br /> 'County-Ordinances, State Laws, and'Rdes and Regufatlons of the Son Joaquin Locr, Hed}h CfalrI Neese eMmer'or peen- <br /> yS agents signature certiRe"fiv,following: <br /> ro f cens/y,that In thr perfwmance of the wusk for which'this permit Is isauad, I shots , :e employ any person in such menace <br /> of be become wb)ecf ro eta <br /> Workn9 Compensation laws of California. - - <br /> S�gn+d r - . Owner - <br /> mother than owtia . Title �� # "... .. .. <br /> r) - <br /> a FOR DEJ'ARTMENT USE ONLY <br /> A'PPL}CATIACCEPT D BY ,.� � ' . DATE­3­ <br /> E <br /> ,; w a.-a ILDING <br /> TIT <br /> ISSUED .DATE <br /> ADDITIONAL.COMMENTS . <br /> ,t�fi <br /> `Final Ins lion by: ...............................: _...Dote <br /> pe <br /> SAN'JOAQLIIN LOCAL HEALTH DISYRICT <br /> zl• E H 13 441'.'68 Rev. 5M ,.... _. _ 7/723 M <br />