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" R OFFICE USE:
<br /> "! .FOR OFFICE USE.'
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<br /> APPLICATION FOR SANITATION PERMIT,6-
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<br /> n (Complete in Triplicate) r Permit Na..ry''7---- ----- -
<br /> Date Issued.T//-`r. i
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<br /> This Permit Expires 1 Year From Date Issued
<br /> :atian is hereby made to the San Joaquin Local Health District for a permit to co stru nd install the work herein described.
<br /> pplication is madelnmp�an ith u in?pc 549-an <ex" t' g ule -Re dtati ns "' f
<br /> %DDRESS/LOCATIONr<- .f e.r ti;, .'t,?�.,-�A. ••`•� {-k�--"c - =- - t ENSIJS. tRAC -'
<br /> It-7 . �r 'hoie:r's Name.. ---AF �.:Y ..- r :,
<br /> 'SS '.. :. �:F:- _ Iw' A _�' E,._ ,,sem;: �City ..{.., s._ . p r
<br /> acto'r's Name.. Licens` Phone _ . 'r `a
<br /> lation"will serve: Residencb' VApartment House t[]�Corilmercial :Trai er Cour = i'
<br /> .Fk.- 1. } ? �,• �,,,, j Mitel..0 �.Othef . -
<br /> M. '!fir
<br /> �er•Af living units Number of bedrooms `` Garbnge1Grin �r
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<br /> t -. - :.e" .z»`� � � "%rT.[.{.a�„-^w.-:W,..�.' �'LT. - �';.�"�e+a'Ck:.•. ""�,r-�•/',,,�,�..
<br /> Supply: Public Systsm and name {:- --- :• m._,,, `_Pd atel❑
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<br /> icter of soil to a depth of 3 feet.-? Sand El 'Silt❑� Clay ❑ Peat a $arid Loamt ° Clay Lopm ❑ t _
<br /> }_. .. Hardpan E Adobe ❑- 4I il}lulateridi_.. Cf yep, type.. '
<br /> )Ian, showing size•of lot, location of system,in , ation to wells, buildings etc must be pIaced orf reverse side)
<br /> INSTALLATIOW" r(No'-septic:tank4br seepage j+t"'permi't'te'd if public sewer is ovailabl1;wi#hin 200 feet,)
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<br /> AGE TREATMENT [ ]' ;
<br /> SEPTIC IANC `' ?;Si2?v_ rc :_c;'!� s� _ :_ ---LEquid De t1� ' ' f -----�-- `
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<br /> > Capacity;�"P .+ Type: Ca�+xL=''Material .': :: _. 's _No Compartments 't '-� •------ ._.`
<br /> .. :Distance;to.near4mt:.Wel! ' w_ �found�ation=� Q;_ ,.. ..Prop -tine_
<br /> i1NG LINE ,t No. of l fine`s ' kr ' en Qthof each lin �/���/' ' ,Tonal'Leri th t .�t f j a
<br /> n' ,F - 1d i� 4!
<br /> Ty�e'F+ItN_ liator�ali= PGfi DephtvF+Iterl�}aterial_-'--_ _---_----- ` � .
<br /> Distance to nearest Well.f_t! '..- '" _f __Foundation Property-Linc-w- „_ �
<br /> GE PIT [ ] D d er. 1`t�4umber_ _ �r Rock Filled , Yes ❑ No
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<br /> Wa#er Table-Dept `_a
<br /> } l�istance:ta4ri citesiz'Well: ......:=-=•�- - ;�: ;:. �w aEauY�- _'._. .�:.Projp.-Line :____: ' :-.- -
<br /> R/ADDIT O ( e� S at'o # x --..` --- ) ---------
<br /> Tank
<br /> N Pr v o 'it n Permit , ,Date:`
<br /> r
<br /> Tank {Specify Requirements}"- • � . ..,._.,_._t„-. ..•:; it _ - #
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<br /> . d ; r
<br /> (Specify Re irem nt+S
<br /> sal Field (Spec: qu e.... ) _,�; � ;. ,, ;... --,.�- . - - -._.--- •,=- •� --v-��-•----_------=------F-:--- -------»-•--- ---
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<br /> --------------------•_.......:------------_ -_ _ _ _ _- _ ._
<br /> ys
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<br /> i ”` (Draw existing and re ulred addition.-on rever side ------
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<br /> sy certify that.l have prepared`this`application ydnd that•the=work will--6-d4 a in accordance with San .loacluin r Cou ty
<br /> 3nces, State Laws, and Rules:and Regulations"of 'the San Joacluiit L*W Health District. Home owner or licensed age"I is
<br /> ure certifies the following
<br /> ify'that in the performancf:'of'Ihe,work' for,wFiich this`permit is issued, not employ any person in such manner as e
<br /> ;ame 'subject to Workman.'s Crtompensation`r.laws of California ', ;
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<br /> If other tharafowrl r) �-
<br /> r. ..Rtt .FOR,DEPARTMENT USE ONLYI"�<,.ti
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<br /> :ATION ACCEPTED BY. .� a' -`- --- '
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<br /> ON OF LAND NUMBER ' x r �x. ' i -I..............
<br /> ICrNAL COMMENTS._?. - 4 -- r s,+ { ATE --- 4 .......:, ... ..
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<br /> } = `�- ""' ---- ----- --- ----------- --- ................................
<br /> nspection by ------•- -------
<br /> < SAN JOAQUIN LOCAL HEALTH DISTRICT! Fns 21677 aev, 7l76 3M.1') #I .
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