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: APPLIC<,TIUN FOR SANITATION PERMIT
<br /> ! remit No.
<br /> "� !Comptele ir. TriF•ti�:h) . .
<br /> —--------� -- _
<br /> Thin PeDate Is,ued '-7 3 7S
<br /> r*�,i;E:p(:es 1 Year From Date issued
<br /> App!,cotron 's hrrrby mol`- the _'nn Hoolth Distti-t for n p^rmit to cocetruct or-1 ins•oll the %cork herein
<br /> c'esc,.�e•d 11, s upp':cat,on is mode -r, cornClicnre ,.with Co.:nty Orklinonce ' o. 549 and existing RvIcs and Regulations:
<br /> .'Olt Af,Dt;E5S%I0Cr0irVa i �' CENS:JS TRACT
<br /> Ar!Jrrit! - C /
<br /> tOnh0Ct•-:r Nan,c .. ._ License # i1/' ' r �' Phone .- . . ............
<br /> insta",ilion w,ll sen•. Residence( ; Apm-Iment Houten Commerci.a! CTrolle:Court 0
<br /> Motei (--I Other -''- • • _
<br /> N.jrrber of !,-'Ing vnita Z t1umI7,r; cf bedcaom, .-% (,orboge Grinder lot Size _. ...-.... .........
<br /> W1 ?Lr S„pp'y: Public System, end nava^ ... ....Private
<br /> Chorocicr of soil to n d2vii, a=5 i;:! Sondr_] Silt r_-1 Clay ❑ Peat C-j Sondy ls.orn ❑ Ciey room r-1
<br /> HardE ur• 21 Adore❑ Fiil bloc. of If yes,type ... .. .
<br /> (Plot olon• showing size cf tot, lecotion of system in relolion to we•I!s, b•,ildings, edc. must I:e placed cr reverse side.)
<br /> NEW INSTALLATION: (No septic to,,' or sr-coocge pit permitted ;t public sev cr is cvo,lable ry:lhin X00 fee!,) �
<br /> P4CY.AGE TREATMENT O SEPTIC TANK f j Size Liquid Death ...... .........V1
<br /> Copocic• Type Material No. Com trnerts
<br /> Dis!onCc to r euros! Weil Foundalicn Proms. Line ..... .. ..... .....
<br /> LEACH.;NG LINE O 'Jo. of bn length of each line Total length _ ......... 71
<br /> Tyr.r• F,!l:•r /A,r'criai Depth Filter Material . ..... .. ........
<br /> (-is!o:•ce ! r._,,eLt
<br /> Well Fovndction Property 11ne
<br /> SEF'AGE PIT Rack Filled Yew L� No Q 4
<br /> -,Voler ToUe ICT-,•F c- Size v
<br /> 5,sionce to necrest' :Ve'.I ,:),in(( oti^n Prcp. line . . ..... .........
<br /> ... W3AIR/ADDITION iPre.. Sar,t,t on Perm 1 9� vJtr )
<br /> Sep'-c Tcr,k (So^C•fy I:e v:rer^_nisi .....
<br /> D
<br /> e,n' n,J an I rcy ir�d odditic-,r,rt reverse side)
<br /> _ I hereby cert-fe '^ot 1 h,•e preparer! this application tend tha: tie work will be done it accordance with Can Joaquin
<br /> County Grdtncncet. ,late Ln s, end Ruler cnd Reguloi o s r-r the Scn Joaquin Loral Healtl District. Home owner or Ilren-
<br /> s•o agents sinnvture :e,tifie! !$ - , 1!ew;119:
<br /> "I certify that in the pericrmance of t..- work for whits this ij—it is issued, r shall not emp!,,y any person in such manner
<br /> o: to bpc. _n_ :vbiect •o workmar's Como<lsation laws c' Csa:iornic "
<br /> U__ ONLY
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