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<br /> FOR Off:CE USE:
<br /> t• FOR OFFICE-USE,
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<br />�+ APPLICATION FOR SANITATION PERMIT
<br /> .. ermit No ... .
<br /> (Complete In Triplicate) #k#til '',, '?*yr `;
<br /> Date lewd!/:,AwP:Ar
<br /> .......................... ... This Permit Expires 1 Year From Date Issued
<br /> Applicatlon is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described.
<br /> This application is mode in compliance with County Ordinance No.549 and existing Rules and Regulations. z
<br /> JOB ADDRESS,':OCATION r _�--�e,�f _ sleep . .. -.. •.. .... .... CENSUS TRACT.................. .. .........
<br /> Owner's Name ._ L �� ..... phoneM=.ZA
<br /> Address........... . ` -x-,0 .. �. . . __. .. .. c'}..�
<br /> city...
<br /> ..�. II
<br />- Cont►Contractor's Name .......... Aicertte ;
<br /> lnstallat,sn will serve: Residence[ Apartment Hous om r of Troller Court ❑
<br /> Motel I] Other.... .....
<br /> Number of living units,. .............Number of bedrooms......... Garbage Grinder............Lot
<br /> ........Private
<br /> Water Supply: Public System ar.d name ...................................................,...............
<br /> Character of soil to a depth of 3 feet: Sand ❑ Silt 0 Clay(] t Q Sandy Loam Q Cluy . )atn Q f'
<br /> "4.
<br /> Horc1p-jnq5 _Adobe fiL FIII Material .rt yes,type....... .. .. , t
<br /> K (°lot pion, showinj size or lot, loco., on of system in relation to wells, buildings,etc. must be pit Nd on reve+se side.l
<br /> NEW INSTALLATION: (No septic t•,nk at seepage pit permit!ed if public sewer is available within 400 feeta �
<br /> PACKAGE TREATMcNT O SEPTIICTTANK size . .�-x�.-.•....... ....»... ..............liquid DepMm"......:..._,.a.:
<br /> Capacity.000..... ..Tyoo... , ...Materiol,.iC/' !M!C..:...No, Corr►partr+nents.....: eew.+..:.. ..,,x,.
<br /> Distance to nearest, Well....... .Ir Foundation..:.� ,.. ..... Prop,
<br />' LEACHNG LINE No. of Lines . J._..................loryth Rock
<br /> e��acc�h line....�.......... .,Tota! Length
<br /> 'D' Box... . ... . type Filter Material—lcoc.Depth Filter Material....», top.,..........,»��...'. •.,�::,y. L
<br /> Distanes to it,Well. ...rts�.�.�` .... Foundettlon.......�.�.t"........Ptep�" iiM...:rt.,l.+.. .
<br /> SEEPAGE PI' "-^th.. Dlameter......3,3�...NumhK. ... ............... +�� Pock Ftlled '1 s 'c NO
<br /> t 'ater Table Depsh................ :.....,..r. ........,.. ....
<br /> ». ....Rock Slzr�
<br /> Distance to nearest, Well........Ow.... ........... ."Prop. Une. . ...,
<br /> 111PAIRADDI410N(Prey. Sanitation Permit tF........ ......................... . ........Date:..............................................J
<br /> Sook Tank(Specify Requlremonts). ... .. ............... , .... ...... ..... . ..... .............................................. . ...........i
<br /> Disposal Held {Specify Requirements) . ........... ............. ................................,..........................,.. ...... ..». ~'
<br /> .................................................. . ,,. .......... .................,......,....... ................................................. .................... �...... .�:."ir^
<br /> �.... ......„... .......
<br /> (Draw existing and required addition on mw,”side) ~.
<br /> I hereby c Airy Met I have prepared this application and that the work wpl be done In accordance with Sen J"1114011e 'fti ►b ;
<br /> Ordleeeees, State lows, and Roles and Re9uladons of the San Jeog011" Loco) Health D15"id. Home o""W WINeetnsed-egiii6i
<br /> 619eaNrre comIll"to"feilewingt '
<br /> "I c"lly Mot in the performance of the work for which this permit Is issued, 1 shell not employ an If pensee to "4&sesMuset!.
<br /> to become subiod to Worke►on's Compensation laws of Callfemle."
<br /> :signed_... .r ............ .... ...........Owner..,/ �.. . ................. ..........................
<br /> say..... tiL.� •ELe. ............. ..................... Title... �.�ei� ..... g:
<br /> Of other thou owner)
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<br /> R DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY......t� ...DATE .l.L.-...••. .••••
<br /> DIVISION OF LAND NUMBER .. . .._ .. .... .......'.... .... ......... ...................................... DATE.................... .......... .............,.
<br /> ADOIT!ONAL COMMENTS.. ...... .................. .................................................. .......... .. .. .... .
<br /> __.. ;.. .. . ...... .. ..... .................... ............ ............ ...................................,.........1-J--"
<br /> .......... . ... ... ..........
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<br /> t'mol ins at b a ,..�.. ....:. ................ .........Dalt,::. ...�.. ... .. .... ....,...... .....
<br /> n.is sr SAN JOAQUIN LOCAL HEALTH DISTRICT sty rev. r��s
<br /> w,.$'u�. ..........oc.�..yy;,q %���.�1�'3�:�sly'ion'.�.':"J6�L'a2:.d"aie�''�.re'91�1'... Y Yk ♦ .
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