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<br />Afp:# PlICATION roit SANITATION rE.HAI
<br />iCernplite In Triplicate)
<br />st,.$ Permit Expires 1 l'eer From Date Iss, I
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<br />II, 'Sister I
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<br />t , nt.- San loo•I lc .1: Health District for a r ,. , t . , ,,, I ,r1st ill tlip vvork herein
<br />mai, In con,t,'.,,,,r.• Noll County Ordirsorve t Ic ',.t• il i - • t • ,i Pyles and Regulations
<br />Jrts : '.r, s• 1( ,r7; •.0P-, ,
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<br />Add,. ‘s ......"'.-->'a /V/ < -
<br />e • t • . irro• . f .., . . •,. ef,., ... /47.,:...4.... Ph•-.ne
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<br />i cons. 5. • • 11 ,,, / 4 tt‘ 6,‘ (e , (tens, b / ‘• • ' ' -) •-•' Phone i/t4 S•••-1 4/T4
<br />:Install irt-.• w•II •• • itissitigyst. )r A p (-1, r - lent NOUS* • Commerciol Tiiiiier Court
<br />Or! 0,t,,, ...i
<br />II% I i tj• ' 1 ',twit Iiif l•r• lio—ns .). Gfinder ‘. L'..1 I, I 1;,:',. /
<br />Wailer it,priy: P,...,:ti., s, ,,.•,•• ondtteirso::,4, • ..f.r
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<br />'P' -... . Private X
<br />Ct4taciitr 0; Sell to'n de it of 3 lecit;:,' 'Sart.l r- i s.lt cr .„.. Peat ' 1 `.; liu.3y 1.. - , Clay Loam n .,,4.,,_ 4
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<br />H#Pipor % 1 , Adotii ii 1 .600 If ,.:s, tyre
<br />,•.,•,...,‘.4.74',;..4.1.:c., 4
<br />If los pity, $h -)x.,4 s.i2.• ' 10i, 11$111(01 Of i , tt ,'n hi '. 114 1,r4 )(4 1;01,1 ,, j . ,,,,..t be placed on reverse side.) \,,
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<br />., ot, A v. . ;:e .„ • • '
<br />N NEW INSTALLATION 0 . ) septic tank or set pc,je pit pertained If public sewer is availoble within 200 feet)
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<br />(Draw ei and required addition on revercr,•
<br />I hereby tertif? thot I Fir:3,e prepared this appliration and that the work will be done in accordance with San Joaquin
<br />County Ordinanct s State Laws, end Rules and Regulations of the San Joaquin Local Health District. Homo owner or licen-
<br />sed agents signature certifies the following:
<br />"I certify thal in the performance of the work for which this permit is issued, I shall not employ any person in such manner
<br />as to become subject to ‘Vorkman's Compensation laws of California."
<br />Anal ji
<br />drier t I. • I 1
<br />41
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<br />-..: '!1 ( ' r ::(1'; TRACT
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<br />PACKAC-E TREATMENT ' ' SEPTIC TANK r ' Size Liquid Depth
<br />D-tonce to nearest V.',11 Fourpicttion Prop. Line \I
<br />C ,tcocity Type Material No. Compartments
<br />SEEPAGE PIT .
<br />s' '
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<br />Eoundat an
<br />s_, No CI
<br />. ler Table Depth Rock Sire
<br />LEACH .NC: LINE .-_. of Lines Length of each line Total Length
<br />Bo v Tyr, f11,sr Material .Depth F.1tcr Material
<br />D,.fance to neorest• s'it,1 .. Foundation Property Line
<br />Depth c ,etmeter Numbe- ri Rock Filled Yes
<br />- i-ze rcy ne:',e .• -,,- Prop. Line
<br />REPAIR ADDITION Pr. . S:^•!Clt rerr1;. ' _ 4 .,... Date
<br />, , r ' <`. ? / •
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<br />••!.!' - T.1.11 .I.L., ., Re " .. I ,e 4- , 4 ' .. 4 _.,... .r_ , , _,,, .
<br />i l • al ' i J :t I, r•el(li' ;Ii ?•A
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<br />. :Title
<br />Owner
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<br />,. ...„._,,,...Fr.; EPARTMENT USE ONLY _ .,.. _
<br />7 ', ., / te-'
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<br />DATE 7- "1 4/ -444/
<br />DATE
<br />LOCAL HEAL fl DIS1 I I.
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