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F OFFICE U' A- <br /> IAAPPLICATION FOR SANITATION PERMIT <br /> Wt-------0- ------ - Z 7MitN0 --------------=-•----- <br /> (Complete in T <br /> Date issued <br /> This.Permit Exp From Date Issued <br /> 7 <br /> X Z'Al L'.fo lotp:I <br /> Application is here i)y made,to the San Joaquin Local Health D r a Ap strA41cl install the work herein <br /> r <br /> 0 <br /> 7,descri 1ratiori is made in compliance with Count bnce �Ao. 549 and existing Rules and Regulations. <br /> Y <br /> 410G <br /> JOB A D PESt A T I N'P' f,27-66(a e Z 0 A b b�j CM------ <br /> ;el - IF- r/, <br /> -- ------------)-------------- --- --------------CENSUS TRACT----------------- <br /> -- ------------------------- ----------- -------Phone-4/08 110-------------- <br /> _rQ -------------- <br /> Owner skN et -------- 117? <br /> Addre 64�------ ----- ------------ --------------------------------------- bt, CALIFIO;?-QXAI <br /> 7---------------------------------------------------- <br /> ST 00 <br /> a P ----------------------------------------------- - 343------- Phone' ��"A----- <br /> Contr tor's Aclme� . 44 bt%P&ZAL -'-----.License License # <br /> 41 L ---Residdna? -NoV -OC-6- <br /> Installation=4Wf'ill serVe XA?�artmeftt Me mm'erciaI'E]Trail&'Court <br /> Motel f-1 Other -------------------------------------------- <br /> Number of-living uniNm------- Number of bedrooms _j------Garbage,Grinder Lot Size -4-------4e4c-s------------------ <br /> f �j 3(ALJ 2-�Ok I <br /> 'Water SUppl�,: Public°SystL-n-r-and-riuiilw --- <br /> ------------------ ----------- -=Private <br /> ----------7------------------------ ----------------------------------------- <br /> f 'C A, � Y, x <br /> Character orlsioilltola depth"of 3 feet. Sand Silt❑ Clay E], Peat[E]j Sandy Loan% Clay Loam 0 <br /> �Hardp4an E] Adobe-E] Fill Alote�,Gf-._ --------- If yes,type �--------------------------- <br />.A <br /> (Plot plan, showing size-,6f lot, Gcation4f!, system ein relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALVATIi _ N <br /> I! <br /> t (No eIj <br /> ptic tank or seepage pit-permitted if public sewer is available within 200 feetj <br /> SEPT --------------------------------- <br /> PACKA'GE TREATMENT FC 4 TANK X <br /> Size--- --------- - Liquid Depth ---!S�4----------------- <br /> Type IA2410C&ASTe No. Compartments ------------- <br /> cipacity ------------ <br /> est: Well ----------------FoundationLine <br /> -4 Distance to near ---------- ----------------Fd ---------------- Prop ............ <br /> ------------------- Total Lenpth,---1S'(3'----------I—— <br /> LEACHIN'GAR4� of Lines ----Z -1-------------- Len h each line-1 <br /> 0- <br /> Box --- Type Filter Materi -..-_.Depth Filter Material ------------------------------- <br /> QDistance to nearestWell`__------- n a ion 75.1--------------- Property- Line. t4--------------J----- <br /> SEEPAGEkPIT lbepth-2.-�X.76-#A Diameter r ---- --------- Rock Filled Yes�K No <br /> SU K.P,5, V -T- <br /> Water Table Depth ------ ---Rock Size ------Z-- -7----------- <br /> K� J <br /> Distance to-nearest: Well ---- - - ------ -Foundation j-.1-5Z-------- Prop. Line ... IV---------- <br /> REPAIR/ADDITION(Prev. Sanitation, Permit ------------- Date .....................:.......... . <br /> Tank (Specify Requirement- ---------------- ------ - - ------------- <br /> S) --- --- - - - ------------------------ -------- <br /> i <br /> DisposalFiei'd. <br /> Q (SpecifyrRequirements) -j------------- -------------------------------------------------------------- <br /> -A I i P-7 <br /> --- - - ---------- ------- <br /> 71 41 1 V, . &1, 4# ­ I <br /> - - <br /> ---------------- --- ---------------------------------------------------------- -- --- -- ------------ -------- - <br /> ----------------------------------- --------------I-------------------------------- <br /> :!I D—raw eii iti n nd r6q6ired-additi6n-on reverse sicle) -4� <br /> all / <br /> work will be done inlraccordarice-IiPirith Son <br /> I hereby cert'fY-that I have repared this application and that the/ Joaquin <br /> ,3 - I �#� 41� <br /> County, Ordinancesl State Laws, and Rules and Regulations of the San Joaquin Local Health rDistrid. Home owner or lic4n- <br /> sed agents signature certifies the'F. i k <br /> rn permit issuecl,-I shall not 6:dl <br /> certify that in ,the perF*r once 66he work fc r which this po p oy any person in such manner <br /> at to become subject to Workman's Compensationf laws alifornia." ,-17 t-- <br /> IDY <br /> Sig d ------------------------------- Owner C-7 <br /> - -- ---------------I----------------------------- <br /> Isc--to AoRe ie-a#-t 0341Y A*.) <br /> Gill 17---------------- --------------------------- --------------- -------- ---- --------------j------ <br /> (if oWer than own-ed k <br /> FOR DEPARTMEIN USE ONLY <br /> APPLICATION-ACCEPTED B - - ----- --01 DATE ------------- <br /> --------- ------------------------ --------------- <br /> - - --------- <br /> BUILDING PERMIT ISSUED.,t- ----------- ------ - ----------------------- -------------------------------- c---------DATE; --------------------------- -- - <br /> ADDITIONAL COMMENTS--!------- <br /> --------- -II- --h-----------------I------- - -------- ---­--- ---------------------------f-------------- <br /> ----------- <br /> -� - <br /> ------------------------------ --- ---- fir=? ' - -- ------ <br /> ----------------------- ------- ----- --------- -- - ------------- ------------- -- <br /> -------------- --- ---- --" - -- ------------------- <br /> ---- ------ --------------------------------------- <br /> - <br /> --- <br /> Final Inspection by - - I- - - - - - ------------- <br /> Date - - <br /> SAN (ZT <br /> *UIN LOCAL HEALTH <br /> E. H. 9 1-'68 Rev: 5M <br />