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<br />,44•71.
<br />. • , • ,./•
<br />I
<br />DATE
<br />DATE
<br />-6p
<br />,,
<br />; /' • ;
<br />1061 f tr.r
<br />I • •
<br />
<br />TION FOR SANITATION PERM
<br />ICe mole.* lit Erfiffeatel
<br />*unit Expires 1 Yier Front Date IssueJ
<br />r• mi., No
<br />
<br />
<br />[tate Issued
<br />
<br />AliplicJi.a. 14 hi44,hy ry-..1,1e to San Mrs
<br />des.c.ibed This,applir tition t,• 1de In corn
<br />!os ADDI4t.SS, OCA 1 tOt (Fe ; .1 1
<br />4 ,:e
<br />ig,L .'
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<br />Alpartnsint
<br />+sr ,
<br />reams
<br />tSilr rj
<br />Ada
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<br />liken in t ;
<br />ge pit
<br />.1'
<br />( ', Typetilie
<br />Jell' 1
<br />
<br />local Heril'is District for a permit tr f t I instn11 the work herein
<br />
<br />Wit* with County Ordinance N. 5.19 %PI, RU(eS and Regulations:
<br />4:49 •
<br />IS TRACT / (s
<br />iliorse
<br />• '
<br />A
<br />Tf gar I ..iiI I I
<br />..t Size
<br />Private
<br />1 Cloy Loam 0
<br />..
<br />Owner's NfIrn• A '.4 la if
<br />NddfiS1 . ,„).‘-,- // i l '
<br />
<br />e , • r
<br />ContleCtor t: Name A ...- 1 4
<br />'rilatIO,1111,41 'fr/1111 totve Residence
<br />q . ;
<br />—Mat
<br />
<br />. . (.:
<br />Numberiol ll.vind un.1 . -- .trumktitt‘
<br />Water Supply, Ps ..43Iic Siiiierti arid
<br />Charade" of sod 4 a r 4.thi. 44:31 3,14A.
<br />f,
<br />
<br />-- --—# I ...1 .
<br />(Plot plan.; s4owing s'iv 4r1 lot. '
<br />
<br />; . t
<br />NEW INSTA-14111,Nti 44 srpti
<br />
<br />/ I
<br />rAcKAGE.TIMAIMEN'T { 1 : SLP
<br />, •i'i
<br />t.1
<br />. ; i• t_abocit /
<br />Distance
<br />kEPAIR ADDITION (Pie
<br />TOr'‘. Sp,..ly
<br />Dispe-11 r e11 .Sri ; rements)
<br />Zk.
<br />/.
<br />14 ".
<br />t•
<br />htfrld 1 tic. n ,' 4" Prop. Line /e.e.: .1")1 1:
<br />4 4.
<br />e
<br />i. ;
<br />length of tacit line fe- ' Total Length ,5"-f '
<br />Moterial/eriiek'..Deptis Filter Material
<br />Property line
<br />Rock Filled Yes 0 No 0
<br />.
<br />nge, etc tiuct he placed on reverse side.)
<br />ovoii• I ble within 200 feet)
<br />t. liquid Depth
<br />411e0 No. Compartments
<br />.•.. .......
<br />LEACHING LINE >(.1 No of Lines
<br />) Box 12 - Type Filter
<br />f);%Hir-e to nearest. Well Foundation /1.
<br />LEPAGE tit Der.'h Diamc;er Numbe•
<br />
<br />Table: Depth Rock Size
<br />r`istiince to nearest Well .. _Foundation Prop. Line
<br />
<br />d Scn,tat•..sn Permit 0 Date
<br />P,qc
<br />[Draw exist and required addition on reverse
<br />hereby certi'y that I hag. prepared this applicalion and that the work will be done in accordance with San Joaquin
<br />C.ounty Ordinances. Store Laws, and Rules and Requlations of the San Joaqu;n Local Health District. Home owner or licen-
<br />sed agents signature cert.fIrs the following:
<br />' I certify 1L5o,.is the p,•rformance of the work for v ,hich this permit is issued, I shall not empli.,y any person in such manner
<br />'is to here ire subject to Compensation laws of California.'
<br />. Owner
<br />• . . Title '
<br />;.,.....,FOR2?Et2971ENT USE ONLY
<br />/.4Vi
<br />
<br />.1 o •-•( /
<br />
<br />.P1-.v.', T. • P •••,#)4, 0 1 • ,71.—
<br />„/•/•/bet / • / /37 ,
<br />iite 7, ,fl I 1OCAL HEALTH DISTRIr
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