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FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> (CompleN in TrlpllteN) Pwmit No. 7d- loo <br /> - <br /> This Pernnll Expires 1 Yoor From Deft Issuer Dab Issued �;I r <br /> Application is hweby made to the Son Joaquin Local Health District for a permit to construct oed Install the work herelw <br /> described. This application is made Im compliance with County Ordinance No. 549 and existing Rules ad Rogulotiom <br /> JOB ADDRESS/LOCATION l- //._- r.- '„•. . '.:�..�; '.1. ... t _ •t�•.�jjj))))a} CENSUS TRACT .�.`�.IR ........... i} <br /> Owner's Noma .............. ................................ ...................... . ....................«........... C <br /> Address ...... %...�,r.At cs�: .................. ............Clty.� r..>>R��............... ... ... <br /> Contractor's Name.Q ...r✓�.. rx...w.r.: ras-i......of..-- -''•t?.......Lkense t ........_ ............ MterN �-?. ..t <br /> Installation will sorvee Residence E)Aportment House 0 Commercial❑Troller Court ❑ <br /> Motel C)Other ........ ........................ ..... <br /> Number of livihg units. ..I ' <br /> .... . Number o/ bedrooms . .,1......Gorbago Grinder ►Of 3b1a .. ..Q..? . .!`.•..............»..... <br /> Water Svpplyr Public Systeme and none ........................... ........... . ...,...........».«..,».......... P►Ivole� <br /> q.oracter of soil too depth of 3 feet: Sond❑ Silt(] Ckry ❑ ►oat❑ Sandy Loam❑ Clr� Levenzo <br /> Hordpon D Adobe Q Fill Motorial 1 . If yes.type.... ...... <br /> ;Plot pian, showing also of lot, location of system in relation to wells, buildings, ek must be pbcod an revere side.) J <br /> NEW INSTALLATTONt Ilio septic Conk or seepage pit permiMed NpWk cower is�available vtnthln 200/eef.)rr <br /> PACKAGE TREATMEh! ( ] SEPTIC TANK(v) .o Slse-�'.......» ..... . .:...: . Liquid Depth .Y......%........»... I+ <br /> Copecity lL 0-:1 __. Type .I4r>rrry" #A10M.AU.?•4. No. Cornpartrne 0 <br /> Distance to nearest+ Well . . .................. ...!rwsetdetlort..., � ... Prep, lone.... <br /> LEACHING UNr '.LJ No. of Lines --oft. of oath Iwo /&o.. .......... Tow twq* ...rZ.�....»....». <br /> 'D' Box " Tvpe Fihw Motorial ,-,q....... ..DepM Ahw Mehtld .-/--.. <br /> Distance to rseorest, Well ... ......... ... Foundation .PO..'............. hbpery/ line .............._......~ <br /> SEEPAGE PIT p► Depth �r Dumais. JU&......... N%A the r'. .. .•.. .. ... Rock Filled Yes J� No ❑ E <br /> Water Table Depth .. Q ........ .__»...........Rock 3ise . <br /> Distance to neorest: Well /r <br /> ............_...-.......Foursdotbn /.TR.......... Props Line .................._. � <br /> REPAiR/ADDITION(Prov. Sanitation Permit# ...... ......... . ...... ... . DaN ..-.........................-._j <br /> SepticTank (Specify Requirements) _ ..... .... ........................._..........»»»..............».» .........._.......»....» <br /> Disposcol Field (Specify Regvirementsl ............ ..... ............................................... <br /> _.............._...»....... . <br /> .. <br /> IL%m%v existing wW required ooditlan an revenue tidal _».»............_�_ »»._..._....»..... ... <br /> 1 hereby certify that 1 hew prepared this application mW Mt stt Ne work wO be Dewe in a.Yordaweo wl* Sew JeNi 4i <br /> Cow" Orrinowtros. Ssah Laws. and Roles and Repu%flom of t%o Saw Jeagaiw Le toll HoW* DkMd.Hecto emote w Now <br /> sed egewts siywv%lum certifies the followilog: <br /> "1 sw"#y ti►r�jn the pmferwsawee of Ilse wesb fw which this perish is isroed, 1 shah not ompby asp pereew IN sed Iwa11 b <br /> « h srbioet ?werbwwall. Coaspowea11 Iaws eel CalMorwies." <br /> SiSIZ7 y�i��L►.. "71:2-4.A0--- ...... .. ....... .......Ciwner <br /> (!f otfser thou owner) <br /> FOR DEPARTpREfiT LISA ONLY <br /> r'PLKAT1pN ACCEPTED BY ! w�'.c. y�...... ._..... ........................................ DATE/L'..k.'.?P.................... <br /> ::J'.iNNG PERMIT ISSUED _. .. ..... ...................................................................DATE......................................__ s <br /> At 'TK-)NAL COMMENTS _- ---................r...._._....._. ..............................................-. .....»............................... <r <br /> .. ........... ........... ... .................... .............. .. ....................................»»..»_.. »..... ........... ..... y <br /> t est. rnn�t.�wa t.Ylt 41r'111T6+ M+CMitT <br />