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<br />;4114PPLICATION FOR SANITATION PEitr4II
<br />iCompleto In Triplicate)
<br />Ths Permit Expires 1 Year From Date icl
<br />'. tr. •I t 40
<br />I t Issued
<br />REPAIR ADDITION Pie..`-:..•nitat Perrni•
<br />Ts;•11. Re .
<br />D .4iy;'•11
<br />I I
<br />G."; : ; :ED
<br />JE:
<br />7- A.
<br />. Owner
<br />. Die
<br />_ FCA EPARTMENT USE ONLY
<br />/i
<br />. ,...,•..-
<br />S;g!-
<br />By
<br />FOR •}(i
<br />Anal. .et •s • t..
<br />dirty I wts• . •.;
<br />the Sort loan . Lc,- Health District for a Isi-' t • ., Ji,i irsstAll the work herein
<br />; inc.!' in (orrmc, mith County Ordi rIce Plc ‘,... , u I ... . ,•ij rJle.. and Regulations:
<br />J0fs ...:):- - v-4-..,,-•••0,-,, .ilel /74.. / — . /...e. , i! :';(..I'l TRACT
<br />. / _jii`°
<br /> '
<br />- • ' ,., , J."
<br />..Vr• t ' b .• srr e )' , ' Ph-me 1 . ''''‘/ " CA
<br />City
<br />Licensi, # j ."-•
<br />„.Initotilti,-..0 will .0 vf Residence }...47)(10-f,eit NOtisoC Commerc.al Troilor Court
<br />.• ,
<br />4)Aiseel Cm
<br />Numi . c ....! ,1%. r ; .j. • . ,l Numti 1,74 10,i
<br />
<br />t.:.7 :13 -',11, .1i
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<br />h.! Sr:r. / at e-le' -.
<br />r
<br />Watt/ SLO ppl; 2,1;11C Sr •,"" and nor* . +. .....,;,, 1t),‘
<br />• Grincle , ,.. t,.."'
<br />Private X
<br />,•-•
<br />4,....t.
<br />)'' : 7."
<br />Cnatod r.1 Sail lai, de. !P of 3 fines,;:;.-Sonsi E . .5 !'Q :,,, -,' Peat FT, 7., .n.iy i •;;
<br />......
<br />: =',1:'•'• : --,.•
<br />:4-
<br />Clay loam L-]
<br />
<br />Hanipafi i- Adobri „.'Material If •.:t,, tyoe
<br />,. .,,:•;,,,............, -
<br />Nk (Nor plan sh.:-..., :.g +4, lot, Incettlari . of sst.ris in • ns be placed on reverse side.) \,i .:.:,- i .:,r.. •. build .• j , :
<br />NEW INSTALLATION
<br />
<br /> \ . , ,eptic tank or ...u. pe pit permitted if public sewer is available within 200 feet.)
<br />VN
<br />RACKAC-E TREATMENT • SEPTIC TANK r. I Size Liquid Depth
<br />Cicacity Type Material No. Compartments
<br />D-.tance to nearest: N.'.',Il .Foundation Prop. Line
<br />Q
<br />1..EACH'NG LINE tic of ones Length of each line Total Length
<br />Type F ,Iter Material .Depth F.:tur Material
<br />%I D. nce to nearest- 'Weil .... .. Foundation Property Line
<br />Depth rl SEEPAGE PIT
<br />
<br /> Didmeter Numbe- Rock Filled Yes 0 No
<br />,ier Table Depth
<br />D .,!;ince to neare;t:
<br />:Addtr 1.a- ..',,c
<br />..t• • ;•• / •.` , Phone
<br />Rock Size
<br />. .Foundat•on Prop. Line
<br />(Draw exist j and required addition on reverse s:de)
<br />I hereby certifi that I have prepared this application and that the work will be done in accordance with San Joaquin
<br />County Ordinancts State Lows, and Rules and Regulations of the San Joaquin Local Health District. Horn. owner or Ikon-
<br />sod agents signature certifies the following:
<br />"I certify that in the perfarmance of the work for which this permit is issued, I shall not employ any person in such manner ob to become .ubject to IA r.cirmon's Compensation laws of California."
<br />1/ .‘
<br />, /1/1/
<br />0 7
<br />LOCAL HEALTH p,
<br />DATE .7-- -17
<br />DATE
<br />e</7
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