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APPLICATION FOR SANITATION PEikt41
<br />iCemptet• in Triplicate)
<br />This Permit Explme 1 Year from Date Its.. •.l
<br />FOR f: ,,tCt
<br />e-/,
<br />ff, r40
<br />it IS Sued
<br />. Owner
<br />. Title By
<br />_ FC,R EPARTMENT USE ONLY
<br />
<br />•• e•-••- / • ,
<br />'V /,, 7 •• ;7
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<br />tOCAt. HEALTH D.STP.V".
<br />Anal At .1, • . •, t., - „ , , tile Son locpi L..:-.ii Health District for Cl p. r f ' ., :rvi inst:111 the work herein
<br />.1....• .. made in corn,nr.. with County Ocdjiçtnce r4c 5:: , i.: i -, ; 1 id,:les and Regulations!
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<br />Jr% fs ;•"3: ..1 tr;,-;,-. t•00,, 7--, / • • . ' kr / • ....... . ,,,,•:::41‘.7,
<br />0 011...• ' $ . • two- ' i 'I, ....? t''• 1..;". L..., /de! ......_„.,
<br />Ada ,,..s •...5-' a 7/IC -
<br />1 Cont• . t- .. t I .- / a.- (e ,
<br />..instail it's:, wdi ,,. y 4. Residence ;-;r., ••-•eit NOUN C COMmerc ,01 — T r oiler Co u rt
<br />. WOW Ctr ,t ,
<br />Nt.e'nt • f ,..! ih. r ; ..:: ' .1 Nutnter if L.-.• ii 3-.•ns .4.;
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<br />Wm*/ aupply: ..t ti 5, 'et- and nom*, ,,..
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<br />:,..r.ii,,, 44t.
<br />Gri,.n.rie , I.: S::;.• / at (le- -
<br />Private -2g , . - --•
<br />Charade/ ot toilta'a de. it of 3 fettSi. Son ,i r 5 It 0 . :..,:, Peat ,'", '.., .,..iy L • . ...-.: Cloy loom
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<br />pof, :. Adobdi
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<br />y, litt,'Material .ii et-
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<br />(Plot plan sh:..... ;,ig ..z, lot, lacrstion of system inreleirlts,•!ter.. Its; &An ., j , ! :•.,,.., be placed on reverse side.) : ;4if ,s1.;
<br />NEW INSTALLATION i!. , septic tank or sui.1;,-.1e pit permitted if public sewer is available within 200 feet.)
<br />PACKAGE TREATMENT : 1 SEPTIC TANK Size Liquid Depth
<br />CApocity Type Material No. Compartments
<br />C;:tance to nearest W.211 •.Foundation Prop. Line
<br />LEACH'NG LINE r:o of Lines length of each line Total length
<br />Type F,:ler Material .Depth F.:ter Material
<br />
<br />.... Foundation Property Line
<br /> Numbe- Rock Filled Yes 0 No 0
<br />Rock Size
<br />Foundat;on
<br />
<br />Prop. Line
<br />c':•:SU'l TRACT
<br />Ph-,ne
<br />City
<br />License or 71.-• 'd f-d Phone ve:....51-1 /:‘
<br />SEEPAGE PIT
<br />0..tance to nearest. 'Ned
<br />Depth Din-neter
<br />'ter Table Depth
<br />D st;ince to nearest. '
<br />
<br />REPAIR ADDITION ,Pre. 5.3nitot on F'errni• Date
<br />Ser..-.• :;.; Re en!st;f .
<br />.ai •!:1Y
<br />-- -
<br />(Draw ex,st r 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 Ordinances State Lows, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen-
<br />sed agents signature certifies the following:
<br />"I certify that in the prformance of the work for which this permit is issued, I shall not employ any person in such manner
<br />as to become :Aubject to tiSic.rkman's Compensation laws of California."
<br />DATE Y.-- }ki
<br />DATE '
<br />Due ---
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