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� Ar,
<br /> FOR OFFICE UFOP, OFFICE USE:
<br /> SE-
<br /> APPLICATION FOR SANITATION PERMIT
<br /> -------------- ............. (Complete in Triplicate} .-7
<br /> Date Issued..2� 77
<br /> .................. This Permit Expires 1 Yeah From Date Issued
<br /> \ t I ". .,•,. e, 0 - work herein described.
<br /> This applicofton is made in compliancR
<br /> Application is hereby made to the San,la.aIll;lZin Local Heo t 1�str' a
<br /> Istria for;-permit to construct and i0stall the WO
<br /> ti�jIity Ordinance No.549 and xisting Rules and Rggiulations:
<br /> and
<br /> JOB ADDRESS/LOCAL iON -----------
<br /> __,....,CENSUS TRACT...a.
<br /> /47
<br /> one
<br /> ------ ...Phone-
<br /> ................
<br /> f
<br /> Ad ...... City....... --------Zip-------------------- ..........
<br /> ress.
<br /> -401
<br /> +
<br /> Ph
<br /> .... - License t one
<br /> - - ------- ... ...... .....
<br /> -r
<br /> il
<br /> will,-sell Recce Aparfxnent House Commercial 'Trailer Court-13
<br /> other
<br /> A M er---------
<br /> 0 -1
<br /> 1-ot,Size-
<br /> of
<br /> Wirribor oilll units.-.
<br /> Water Supply: Piublkz mo4dt
<br /> .,n
<br /> `1 - , —W--,?"C] Pay,Locirn D
<br /> 'Cloy El VScndy
<br /> Chi3rocter of soil to a depth of 3 Sand, ;,Silt El
<br /> 4� e2-------
<br /> I Mdteridi.--. -if Oil
<br /> ,
<br /> l4a4an 71': A&bi En
<br /> ,:M
<br /> n must be systemplaced on reverse side.)
<br /> of fol; ]occiiEm i�f in relation to welis,buildings,(Plot plan, showing -Size
<br /> frgu@ic seNwer islov�tVable within 200 feet,}NEW INSTALLATION: k or seepog*pit perrr!i
<br /> �-[-]--�`SEPTlC`TAN ................ -_Liquid Deo
<br /> PACKAGE TREATMENT
<br /> V
<br /> o.-Compoliftrnents-z
<br /> 1 .
<br /> Capactty-ta-'.2L.ZA—iTyvil:�-n...... ------ --------
<br /> 1, : I , ,: , 1 1, 'a.� . 0
<br /> ddill, , _.; . ........ -------A-
<br /> MI Fro
<br /> Line
<br /> X
<br /> I] N*
<br /> VTotal Len ........
<br /> LEACHINGVNE f Lines. .,,,1ength61eacl Iin .
<br /> I
<br /> .. ..........
<br /> ,pB K.4;1Typv Filter ...... ..........
<br /> Material ept,� Filtii.mci
<br /> UrI--------
<br /> Foundation _
<br /> %
<br /> SEEPAGE PReck Filled Yet D No
<br /> IT -------- F
<br /> Water Table;,Depth ------------------ ------
<br /> Distall
<br /> REPAIR/ADDITION (Prev, Sanitation!Pell
<br /> Date ---.--
<br /> ---------
<br /> Seitic Tank, ------
<br /> tSpecify-Requirerrfent4--n III, �0 i
<br /> Disposal Field'(Specify Requirements,),�.,.
<br /> .......... ------------......
<br /> t.
<br /> #:&�-�=-,---7----------------- ------------
<br /> ----------------
<br /> ..............:------ ..............
<br /> ---------------------------
<br /> hj
<br /> (j)ial existing and required addition on reverse side)
<br /> with Scri�: AacquinyCounty
<br /> I hereby certify that :,f.hJ ap)#.. tion and that the -w 'k will be, doill accordance'
<br /> OF in
<br /> ,a** Preparill 'll agents
<br /> Local Health District. Home owner or licensed age
<br /> Ordinances, State •Lcnvs,, -gfid �qlotil of the San Joilu�q
<br /> signature certifies the following.
<br /> "I cerfily'llill in the performancir of the work for'Wh.kh'thii permit is issued, not*mPI0Y MAY pemon in such nianner 4 as
<br /> to become subject # I
<br /> W* all MPG
<br /> -motion,lqws.of California,"
<br /> ---•--Title.. ..........
<br /> BY......... ---------- ........... ------- ------
<br /> EPA MEW USE ONLY
<br /> ----------- E:
<br /> APPLICATION ACCEPTED I
<br /> DIVISION OF LAND NUMBER------- ------ ........ .,-,.-,DATE.---------------- ---------=-----------
<br /> ADDIT16NAL COMMENTS......... ...... ........ ------------------I----------
<br /> ---------- ................ ------- ............. ........... ------ ------------------ ...........
<br /> ...... .. ...... ----------------- t i ........ -------- ............
<br /> ----------;L;; ------------------------------
<br /> ------------ ---------- ------ ------------ ....... .. ............
<br /> .......Date
<br /> ll"ZFin.61 Inspection h1l - ........ ------------ ........
<br /> CH 13 24 JOAQll LOCAL HEALTH DISTRICT F&S 21677 REV.7/76 31%
<br />
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