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FOR OFFICE USE , ie fpR Of NCE LINE: <br /> Vie <br /> APPLICATION FOR SANITATION PERMIT <br /> iCampbee in TNolicotel Permit No. 79f/©s <br /> - Dote Issued a <br /> - I This Permit Expires 1 Year From Data Issued <br /> Appi_ceriain is hereby made to the Son Joogsln Local H.. Ph District for a permit to conttrvci and rPisioil the weak hetem aescn6od <br /> This appl-cation,s mode in cam LoMe,wah_Coun Orairionce No S G on exrsn �es R alar ons. <br /> '[f(- .v•-u.cucir,e.Au.v.•+ -,e j.. ,c ,�l7x_,� �°sf t�q-Tp&n,?/ <br /> JOB ADDRESS/LOCATI �.n Ar `� 1 ,J� 4e CENSt15 TRACT <br /> Ovrner s Name /!+40_ti / /s.•.+ J Phone <br /> Address �J _Qt?k <br /> {�'1 - city_,Sy-" Zip.. ._. __ LContractor s .�Name Y► .... . License 0 y�� Phone J�L. 4A <br /> Insiolial on will survey Residence U Apartment House ['t Commilraoi Vr--Miler COort ,-t <br /> Motel l Other <br /> Nw ber of living units _ ..Number of btdroorns Garbage Grinder Lot Size ! 7/��— <br /> Water Supply: Public System and name f Private.tom <br /> Chorocrer of sort to o depth of 9 feet. Sond ❑ S s o Cloy 'L" Peat +dy Loom [] Clay Loom <br /> Hwelpon L Adobe E) Fill Mate,.o# It yes, type <br /> - <br /> iPloi plan, showing site of lo•, laccuon`of system is rotation to wells, buiidings, Nc. must be placed an+avarse side.I <br /> NEW INSTALLATION: INa septic tank or seepage pit permztled it public sewer is ovadable within 406 feel,l <br /> PACKAGE TREATMENT j•) SEPTIC TANK Pr__� Stray G f! zJr.//i�/♦Y� . � Liquid Depth/ � <br /> CopooIV /40!mV400 Type CT 1 Material No. Comportments._ <br /> D,stance to nearest. Well �(D, u _ ( Foundotion f / Prop. Lirbe i!r/ - Q <br /> LEACHING UNE <br /> v W.rSfr/'l(`T Jr„ No of 4ncs !c ' A rX G-Q-" � l <br /> �...- <br /> fir <br /> D BoxJP� Type filter MOIse,ol `Te.r- Death filter �tan� <br /> Distao <br /> � <br /> nares! Wall .!� +�� / Foundation ., — Property line <br /> SEEPAGE PIT j Depth- D,OcneTer Number Rock Filled Yes ;_j Nolit <br /> Water ToWir Depth _`Rock Sita P <br /> 1 <br /> D,sra-we to ncarast Well � .foundation. Prep. Una <br /> REPAIR./ADDITION (Prev, SonAonoe Peirnit a - Date 1 <br /> Septic Tonk (Specify Regwtomenht <br /> Disposal Field {Specify Requatime*t9 <br /> iDraw exst,ng and regwrrd aod.r,on on reverse side" <br /> I hereby certify that 1 have prepored this application aed that the weak-will be dtstiiiAn ottordentTwith Son Joaquin Ceu+ <br /> Ordinances, State Lows,-ond-RIJes end'Regulotiems of the Son Joaquin Local Health Distrix. Home owner or licensed age <br /> signature certifies the following <br /> "I certify shot in the Performance of the wort for which we permit is issued. I shell not ornplay any person M such tnoener o <br /> to become iub(ecs to Workman s CempemOFOn lows of Califarda. <br /> &-gned Owner . <br /> By ... GLS Title ��!! <br /> Ilf oth r1'an owntrl <br /> FOR DEPARTMENT USE ONLY <br /> DATE <br /> APPLICATION ACCEPTED BY DATE <br /> DIVISION OF :AND NUMBER 1 <br /> )IIIONAL COMMENTS I <br /> Date N'9 ' f <br /> Final Inspateraa by:. ' <br /> ru ren rv.Int tr <br /> W 12 34 I SAN ;OAQUIN LOCAL HEALTH D RIOT <br />