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<br /> FOR OFFICE USE: APPLICATION FOR ;SANITATION 'PERAIT 7.2
<br /> �.... ........:.........................
<br /> P o. .....................+
<br /> .......... !Complete in Triplicate) '• _ :
<br /> Date issued
<br /> p
<br /> ..._........
<br /> This Permit Exp ires 1 Year From Date issued `
<br /> e
<br /> •' ..._..._...•._.__ .-. "' h
<br /> l the work
<br /> Application is hereby mode to the San Joaquin Local Health D'+strict for a permit to construct '549 and existing Rulestalnd Regulations.-
<br /> rein_ +.
<br /> described. This application is mode in compliance with County Ordinance No.
<br /> CENSUS TRACT •-•_
<br /> I JOB ADDRESS/LOCATION .._...�}!.... / i`���r- � ..... .....`. P � A �
<br /> :'11 d4 /� hone
<br /> Owner's Name r7G•G� ` .,'....... �!le ... ......
<br /> .. ., City
<br /> Address
<br /> -�.,��.:•-���� :.:..__.:. --- - •- ...........L';cense-# Pht�n��,2�l,�,�f!f
<br /> Contractor's Nome::: a .. x
<br />' Installation will serve: -• -Residence ($Apartment House=❑-Commercia! Trailer Court {]
<br /> ;❑Other ..... ..•••_-•-:•••• »i •.,' .. �G
<br /> —Motel _ _ s�
<br /> 3 :
<br /> ge Grinder .. lot Si a,
<br /> Number of livin units•... Number of:bedrooms___
<br /> g Garba
<br /> I • . _ .. :-•- � Private.� ,. ..
<br /> Water Supp Pubiit System and'name .............................. ,
<br /> Cla Loam
<br /> Character of soil to a depth of 3 feet: Sand ❑; Silt❑
<br /> Clay ❑ Peat❑ Sandy Loam t Y ._i.. ,.,..•
<br /> Fill Material _ . Iyes,type .
<br /> � : and an Adobe (� f .—A.............
<br /> .-s.:_::••
<br /> buildings,-.i�tc...must.be placed'on reverse,side.)
<br /> (Plot plan, showing size of lot, location.of,.system_in;reldtian to_.wells, e
<br /> k • - J ....
<br /> No se tic tank,or seepage pit permitted,if public s
<br /> wer.#s availcble within 200 feet,j
<br /> NEW INSTALLATION• ( .s P :.
<br /> L#quid Depth .. •:......
<br /> PACKAGE TREATMENT ( ]' SEPTIC TANK'( ] � � Size � �� X
<br /> ,c.c•��PnAdte ipl No : Compartments
<br /> ( Capacity ._ U'0 _ Type F� i
<br /> n. . r¢ .............
<br /> { Distance to nearest: Well -_ • ....• Foundation f Prop. L
<br /> _. _. Pr �
<br /> s Ii ,.... Tota( Length
<br /> -Q ine ..�
<br /> Len tli of :each ne._ ,
<br /> LEACHING LINE ( j• No. of 'Cin,e - g / / h 'Flits
<br /> t
<br /> 'p' Box -- ... TYPe /�. d � '
<br /> Filter Material -- ��Dep
<br /> tr Mater( I
<br /> 1 b ._ party Line
<br /> ` Pr
<br /> Di ton
<br /> nearest:°Well
<br /> Q R:-•���° Foundat' n
<br /> i �y 6 Number i {Rxk-'Filled _Yes ❑' No Q
<br /> SEEPAGE AIT [ ( " ,Depth � _ : - DI:meter .... i �
<br /> �.�...�" h° i ... Size
<br /> r Water Table Dept
<br /> -Rock
<br /> } prop l Ina __ -
<br /> c _, vy}
<br /> i Distance to neo�est Well`_ ` Foundation `
<br /> t s REPAIR/ADDITION Prev: Sanitation Permit�#t #'" ...................• Date
<br /> 'Septic Tank (Specify 'Req irements)# _rj{ .
<br /> M
<br /> T
<br /> 7 4 ..... .. .•
<br /> Disposal =Field S(Specify Re uirementsl ............ `}
<br /> I 1 P y a ...: . .. � _. � 6 ............'.................
<br /> f
<br /> .7 ......
<br /> {3 .�.: _ _..........
<br /> __.._... _ -
<br /> .................r�.....r__. ... ..,
<br /> (Draw existing and required ciddition on reverse sidel i,-•.,x , .
<br /> I hereby certify tht i have pre area this apple atiori and that`the work will be done;in atcordarice With San!, Joaquin
<br /> q
<br /> R
<br /> County Ordinances; State Lawii'and Rules aiid.Rego idtions of the'Sairi Joaquin Local Heplth pittritt:"Hones evvrior,or liter'
<br /> a., s
<br /> sed agentssigriiRure certifies the following: } @rrriit is issueef,`.I shah riot employ any person in such manner
<br /> "t certify that in thb performance of the work fortwkich this p € , pi--
<br /> as to become 'subject t W asti/s�rt+pansation laws of California.' ... j �—
<br /> {��� �, � ' _ Owner ,.. ,,
<br /> Signed =
<br /> tlier than owner) �'
<br /> Sy
<br /> '
<br /> (Ifo .• _. ,. .,.< ... :x. .;.:., �.�. •., , .i-
<br /> �. .. _E: DEPARTMENT USE ONLY.
<br /> s _ _ DATE
<br /> . .. .
<br /> r' APPL{CATIC►N.ACCEPTED BY ..-`- •-- •- _ _ •
<br /> DATE ._. x 5.:.
<br /> BUILDING-�PERMIT-_ISSUED —. —.
<br /> - , € ;i _�
<br /> -, # ........
<br /> ADDITIONAL COMMENTS ...... '' : l
<br /> .. ... ..
<br /> .
<br /> .._...�. - - r
<br /> - _
<br /> . -.. _ t S.
<br /> .. _
<br /> • - 8 >w
<br /> Final Inspection bye ;•/fir
<br /> .Date
<br /> ,._. ,,,,.,...•,.:,. .., __ .� _ ICC 1
<br /> i `SAN JOAQUIN LOCA FiI:ALTH D
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