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FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT l
<br /> .................. Permit_No
<br /> (Complete in Triplicates
<br /> E , Date Issued
<br /> -.This Permit Expiris.t Year hong dote-Issued ,. . .. ..•- , t t
<br /> Apnlicatlori`is;her eby made to the San JoagL)W Lbt il"HealtFt District for� permit to 'construct and Cristal! "the wa�1c•fierein
<br /> described This application is made in Compliance with County Ordinance No 549 and existing Rules and Regulations:
<br /> JOB.ADDRESS/LQCATION.$,-p5. Q94P A: .. ...� �L��.--••�' ��'..;. _.....CENSUS TRACT
<br /> l
<br /> Owner's Name -:
<br /> A { { I i ... 1 City . 1
<br /> s 4 3
<br /> Address � '_._ ..._ . _��_ _, • ��.�� •-- ----- �-----...........4---
<br /> .
<br /> - (
<br /> Contractors Name Phone ...... ...........*•-.-
<br /> thitaltation will serve Residence Q Apartmenttt House p Commercial flTrailer Court i ,
<br /> = Motel Q Other-_ ... .. t
<br /> A ' :Garbd a Grinc(er ` i
<br /> ,
<br /> Numer off living.units .::��..7 Nurnbe� of;bedro Ms'!/ . g Size '
<br /> f. i .,, ! C ► k l.ot 4'k . € -...,.Private � w
<br /> . 1r
<br /> Water Supply. Public System and name - <- - d
<br /> L.
<br /> ;t .. .,f r... ..._._..£.._ . . -. .� i x N y
<br /> � p EI D fl y 0 ❑ y_ bciim:.-0 = Clay laarrt p ;. _. ..
<br /> C�hardcter of.sacl too depth of 3#��? Sand Silt- —Clay. "feat. � Sand C,.tyPe � i �
<br /> g i Ha
<br /> r
<br /> t cd an Adobe Fill Material tflyes ..
<br />! (Piot°plan, showing site of'lot"location.of systerh!:in lelatlon to'wells, buildings;":e#c.trnuat be plated on reverse side-)
<br /> NEW iNSTAtLATION: >i 5(No septic tank-or seepage pit permitted-if public sewer is availbblewithin,200 feet,a 1 '
<br /> F / ; i f
<br /> . PACKi4GE TREA'CNIENT- (.].. .SEPTIC,TANiC� ,a=, .tt,- W Size ,l�7.__ .:.1 ._.. .5..... ; .. Liquld 'Depth fid:..•.:....... .
<br /> 1 .Capacity/ 4 Type' �. _.Material. 4r� -.., No,,Compartments` .. •-
<br /> F - _
<br /> 1 , .... - k
<br /> ( Distance.to no est We i �? 1 on l° oP + o
<br /> _ _ FoundaH Pr Line
<br /> lEACHING LINEIrJ No of-lines ( �� ' Length afeath Zine_ 4?�'l`-..' a Totals length. ... ` .. 1-
<br /> 5 TYpe"1"ilter,Material �' • LDepthiFdter Material �� •• -- -- -................
<br /> i 4y 4 Distance to n ares#. Well �. ?�. 1. Foundation /4 - Property Line ._. ' . ... -
<br /> SEEPAGE PIT" "'• "Dep#h : 5 -- Diametev- -k N. Nutnl er ._:: `::: :.: ` Rock Filled Yes [ No Q
<br /> ..< i ' x i / -Rock`5ize:ll. '.". ..... t
<br /> Water Tdble Depth 1
<br /> y"
<br /> a , f i 1 :..L ..Foundatiori . ., .-- Pro !lime ..
<br /> Distance-to°nearest::Well 4 P•'
<br /> REPAIR/ADDITION Wrev. ScInitation. Permit -• i f
<br /> tt ° .�.- _ __ _Date
<br /> Septic,Tank (Specifyltequirements) t.............z i 4. f
<br /> i - -
<br /> Disposal Field (Specify TRequirementxl -;
<br /> l � 3 � �
<br /> ------------- -------- -
<br /> __.._... --- --...._ f
<br /> -----------------------------
<br /> �" 4kai ",•'TM w-. „•q,_—ex,.N66w-existing"rind required-additlon`on reverse-sides - - -
<br /> I(hereby:certify.that J.-have prepared.,this:,Application.eind.:`th af,.tlte.work,tivill.6,clone•.in i accardanee,iwith,San Jloagt In
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<br /> County Ordinances, State Laws, ared'Rules'and'Regulafions'�of the San :ioaquin Local Healtlr:Distrlct:Home owner or licen-
<br /> i sed agents stg ature sertifies�the`foll ,kwAj: "". ° »� a ,T•_ ��_, ,- ,...f i,..,.,•,,..m„ ,. ..,K• ,..y, .,.1_ . (.. .:,.,tl "`�
<br /> "!.certify that in thee.p4rFor"nie of.tho work.for,which.this perimit.is issued, i shall_ not employ any 1person in st th manner
<br /> as .to became imblect to Workman's Compensation laws of Callfornia."
<br /> ,� � zsm.«.. +r` � n9-r-o+� ,.avea�.!„aw•r�• • - •-M1• a ., •, �,.:.• •,+a-.e.o a of .• "j
<br /> S.. ed 1 i I_ iwi � ._ OwnerW. +R I i , ■
<br /> iigns ,_... ;•__• r•aw i,;ia YRY,.%.•L+. .�•, .Y MBy 1 t a 1}. Title z1 ii s
<br /> f L.�ree{if,other-#hanownerl.. .�, r_,•rt w.q.. 4.;... , w». e.r e..•a .<,....#Y. ..,e. .., ,,.r+` ._. ,.,�� '� -r^
<br /> FOR ?DEPARTM €.
<br /> .. F . # g I
<br /> Ai'PLICATipN ACCEPTiD.BY C
<br /> i i y..----_,DAT ,_.. ....
<br /> i3UiLDING`PERMIT`'iSSU1=D ............. -------- ----- ------ --' DATE -' - ....... ... ,.
<br /> ADDITIONALCOMMENTS --------------••--------•--._------•--•-- ............ ------------------------- ------------ -------------_----------- .......................... ------
<br /> ----------• ----- - ---- -------• ----------------------------•------•--_---_............ -•-•- ....-..-•--•----'---- --- - --•-•---- ----------
<br /> --------------
<br /> ....................................--------...•...•----................-------- --- - --
<br /> i ..... _----••---•-Date!.. :::-----'
<br /> Final inspection by: .._......--'------•-•-•--_... S'
<br /> t ' EH 13 2h 1-68 N JOAOUIN LOCAL HEALTH DISTRICT 874 3M
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