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?� a}� <br /> FOR tF� USEI FOR OFFICE USE, <br /> _ AMLICATION POR SANITATION KR/NtT ,FSvZ <br /> .. ., ..� I1 INIn TrIpIkoN) Permit No77 <br /> �."...� r .»..... •' ►,� �* .. Date Issued 17 <br /> *........:.:...:..:............................^'.... ",.-.•TIrM•/wwlf ixpkes 1 Yew Fnm Dere Issued <br /> ° kpflws hereby made to ft Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> 'pppllooiion,is mode in Compliance with County Orth No.549 grutpxistinij Rules and Regulations, 1 <br /> J�rw <br /> -J <br /> f,�} ♦. <br /> . ......................................City.. zip..... ................. <br /> �. . . <br /> -r <br /> License f.. .7./S3Q •.Phone.yf'....'I <br /> ttll�f�•rr '�.�' Rssldence❑ Apartment House Com erci ❑ Tr Iler Court ❑ <br /> •_ 3 Motel ❑ Other... _. <br /> N baciolWuniri, ; of bedrooms............Garbage Grinda..... ......Lot Size fr14-C-4-44- <br /> - <br /> ing <br /> Olslt8upply,Pub]kSystem and nome.................. ......... ............ ...................._...................................... .......... _ .... r va <br /> r to <br /> -soil to a depth of 3 feels Sand❑ Silt❑ Clay❑ Peat❑ Sandy Loom 0... Cloy Loam❑ <br /> r Hordpon❑ Adobe W Fill Material., If yes,type. <br /> jlcwir►p size of lot, location of system in relation to wells,buildiNs,etc must be placed on reverse side.) <br /> ';11TALLATiONt • jNo septic tank or seepage pit permittee] if public sewer is available within 200 feet,) <br /> 6 IA�'KACsETREATMENT j J"SEPTICTANK ( ] Size.......................... _.-..---------------..Liquid Depth ...... <br /> Type..................... .Material......... .. ..... . .....No. portments ._... ._ <br /> 2k YY <br /> } i .;Distance to nearest,Well. .. ..........Foundation. _. Prop. Line _ ........... <br /> .No,of Lkws....... .............I...Length of each line......................._..__Total Length ... ............. <br /> 'D' Box............Type Filter Material.... .... Depth Filter Material........._......... . ... . . .. ............. . <br /> ;w <br /> T., <br /> ' coy '���.�� ,•� �{� ,-D{stp4altO nea►a/th Well............................Foundation .................. ._.....Property Line _ ... . ...... <br /> ❑ <br /> ....................Number... Rock Filled Ye No <br /> ........ ..................... ...... _. <br /> �'.�ptfs .Diameter s <br /> y ,I;... �'`�`.Wahr 1ob1e Odpth........t... .............._............ ... Rode Sure / <br /> . Distance to nearest.Well............................................Foundot:.xt......................... prop. Line <br /> /1110nM001(prev;Sanhatkm Permlt/I:...-. ..: ............................... ) <br /> ... <br /> Tank: h .................... _..... .... <br /> ,�t�ojci) lFieid tSQedfy Reyulremennt..�/ZQ � _ <br /> . I L" <br /> ----------------- <br /> ............ ..—....--••---...... .......... . <br /> {Draw existing and required addition on reverse side) <br /> 'a, ssfrlilY*W.l'MNe I It ibis piFtdfew whd that the vm& will be dew In accerdance with Saw Jeegvin Cewty <br /> y fMs <br /> Lows, an •d lle$•emd Regulations of ties o <br /> San Joqalt <br /> ule Local Heh 0hrmil t. Hewes ewrwer or licensed agents <br /> oil fools kv 4W . <br /> !'1 eerfiy Neat In lbe 'erferwowci aflill a work for which this permit is 6wW, I $ball wet awPloy any Person in sw:b .teener as <br /> r'to a W 's satlou laws of California.- <br /> . ... ...b . `r'�r... <br /> y"- ... ......... <br /> (If other than <br /> FM DEI•ASTMWT UM ONLY <br /> PIP I <br /> APPLICATION ACCEPTED BY_..... .. ..................................._.........._................DATE A 24- ....................... <br /> DIVISIONOF LAND NUMBER .__........._..._..-_-........................................................._........ .... . DATE.. . ..... ..... ..... ................. <br /> ADDITIONAL COMMENTS........._................. _..........................._...._..._..........-.............. ............................ ............. <br /> _...._._........ <br /> ................................................_..-___- ..r.._ . - ,�:.:..-..... ..�...~..�......... ........- ............. ...............�.....^ ....... <br /> -M..-.... <br /> • ............................... pale. ... <br /> ...�.+► <br /> Final Inspection byt................ . ./ ... . . `.... ......._._....... . l{// �i?........... . <br /> ., w u u JOAQUIN LOCAL HEALTH DISTRICT <br /> c,t. <br /> 1.4 <br />