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<br /> APPLICATION FOR SANITANON PERMIT
<br /> I Permit Nn - .' sa
<br /> (ComplePa in 7riatic©t91 • •,r "'�
<br /> T1-ie Pa'mit ExPln:c 9 Ywrir.From D",e iaavori t
<br /> Ajrin,ii :tiicYl IS I r•fe I?y nlrlriC to r` JU rl .i J.7rl.. rl LG.'nl {Or t (',nr"int tJ Cps iii Vel -In:4 �n"v;i Pn" C•J r„1 F3•a?�n ,r
<br /> dr-%Crii'.ed. TILS C1 lrcalion i5 n'.;7rle in (omrdionce wilh Covni`: Ordinance No 5.10 nn.! exist n•"r R•110; anti Ft`t 01,110n4:
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<br /> lOR ADDRESS%LC)CAT101MZt,,7,,Z1v `r �� �"f/��/��f��/T!/�«!�� �dJ�i¢�1y• CENSi 4C7
<br /> Ov:n^r', Name /�ly���A-Y Jn✓/ �,+ IdA i'hcI J.
<br /> A,Hross z /� rL .0 ���d'`!>ri v"Y /�� o/; i,+Y:d� City ��/AL'✓f41 X-
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<br /> Contractor s t ir;rne�/Crh�_ iC� _.Sari%/C / /s�i!�.r [icons;
<br /> ✓t �-� � ,, y .�..5-S` -� "
<br /> InstallotiGn will tnn'r+.• Resine•nrl+ fr•✓'fnctrtment Hoose r_� C'rnmo;ci;;l �—;railer CGur}
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<br /> Mot.-i I q,her y -Ng
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<br /> r•lumher of living units. 0 Nurni�er of hedroo;n; •..;i (,.-trhoge Grinder ,"J Lol •'
<br /> Wrater Supply: Public Sy%tern an�! name Prn'at,•
<br /> Charr;rter ci soil Ip(l depth of 3 tett• Sancl [g'YrSiL' D Guy F, Peat( I Sandy loam j :i,ry i.onm
<br /> ttrlrr;i)rin I r ?bo r__, Fill /v'woriul li ye;, t',k;.'
<br /> (Plot )Ian, showing size of lot, lorotion of sy*«tem in relation to wells, bulid'n9s, «-tc. most i r i):acu,i on reverse Z;ao.i
<br /> NEW iNSTALLATION! (No septic, tank or seepogo pit permitlod if public waver is dvn:luble within 200 feet.) lee
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<br /> PACKAGE TREATMENT j j SEPTIC TANK [� SiYa 9;K.� +ti. -� � Liquid Dopih
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<br /> copocit y/r•letL! ,Typo wv'a MutC'riei NG. Comncornonta - t . tj t
<br /> i.7i Ltr;nr?' iC` err;rr;t, Wr.•II r FUur}iintion �+*:/ r Pro,.. line +. :J
<br /> LEACHING Ui`ac Na. o! lines Length of each line r
<br /> D' Box A-' Type Filtor Mutorioi Ttil)ar Dopl'n f,Itc+r Mutoriat •��
<br /> Distoric(, to or'art9•,t: ld'd,*Il r Eovndotionf r0
<br /> t porly ono 4�. .... .
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<br /> SEEPAGE FIT t j Depth Diameter Numho• hock :'thud Yea i J No
<br /> Woier Toble Depth Rock Size ;
<br /> Distance to nPLJrr;,t• W(Ill ..Foundation flrop, i.in+u
<br /> REPAIR/ADDITION(Prov. Sanitation Permit'i!
<br /> Septic Tank (Specify Regv1mmnnts}
<br /> .eA.....P llle✓'�i°.� : 40"-A.Aa
<br /> •�' /e� d��E��'�'>aG'r'r'� ,,l d.0..r9 •-��1.�1,.�"J9� .d�.r/ft'.�>ri���/`' e �,0�''y�r''+�`'c`y��f �y'g" to �`v _�
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<br /> (Draw i-osting and rocivired addition on naverw sir.!oj
<br /> I horo'by certify that I have proporod this application arid that -,iia work will be dons+ In CttCa>rl3,yrccG with Jern ,cot;;.iJA
<br /> County Ordinances, State laws, and Ruies and Regulations of the Sun Joaquin Loa al Health District. Nostra owsaar c: heart-
<br /> sad nytenls slgnuturo certMes Pho folfowinut
<br /> "I cortify that In the ptolormane,r of the wo?k for which this permit Is Issuad, i shall not employ any parson in such man:sof
<br /> as to hecomo subject to Workman's Componsull n laws of California." '
<br /> S.anad Owner i
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<br /> (If other Phan ov.•n«•rt z jr
<br /> FOR DEPARTMENT USE ONLY 1,';-:�
<br /> AIT[K'Ai ION AC(EPT D BY f 1 �� .(.i DA1
<br /> r'l;liflir;G i'I"Pn".I1' IS UEP DATL
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