|
FOR OFFICE USE,
<br /> SANITATION PERMIT
<br /> ......................1. ...,..: APPLICATION FOR
<br /> Permtt Mo. 7S 7d-�
<br /> :............................... ..
<br /> ICompleh 1n Tripllcatel . .....................
<br /> .......
<br /> ... This Perini+Expires 1 Year from b Dans Issued .h........
<br /> Date Issued ,
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and Install -the'Work herein
<br /> described, this application Is made in compliance with County Ordinance No. 544 and existing Rules'and lfegulationse
<br /> JOB ADDRESS/LOCATION •`7._� �.�_ ,ia'.:..�rf���5r/:.�;... �::......... .............
<br /> Owner' ... :.....»...........CENSUS TRACT ..,.. ...,..
<br /> s Name � ,C�...., � ................ ..................... ......... .. Phone ,. . .........................
<br /> Address ....�,�A .. .,� .... .eG �17...�s 'city r� .r� .7. °.�, ..............
<br /> Contractor's Name ..�/.�.,.7� 6 ....... ...................License e . /.,..�` . P �
<br /> one ��'.:
<br /> Installation will serve: Residence Apartment House[] Commercial 13Traller Court E3
<br /> Motel Q Other................:..:....:..............
<br /> Number of living units:../.... Number of bedroom$ ... r....Garbage Grinde'r.,l../.fd... Lot SizeZA, ?4W-0..y� .�
<br /> Water Supply: Public System and name ..... ................................ ... ................... ..Pr ...
<br /> Character of soil to a depth of S eet� Sand �;Sift�{; ��,: f..� ,�..,,. �Q;
<br /> _ _ ,CIaY.01 Peat Q Sandy Loam. CI Loam
<br /> Hardpan 0 Adobe 0 Fill:Materlat............Ifs
<br /> Ye type.......
<br /> Mot plan, showing size of lot, location_of.,system<In...nla0ion.»to_we1f:,-buddinos,.etc.- must be placed on reverse sides
<br /> NEW iNSTALLATIONt (Na septic tank or seep
<br /> ago permitted if public sewer 1:available within alb feel
<br /> PACKAGE TREATMENT SEPTIC TANK x� '
<br /> 3 S#re.,....»...:.:..:.. Liquid. Ihtpttt .......
<br /> Capacity .................... Type ...................I Material,............... . No. Compartmenh..........:..... „ -�
<br /> Distance.to nearest: Well ---..................................Foundation ....................... Prop. Line.....:......... ..
<br /> LEACHING LINE ( J No. ....I.-....:.......... I
<br /> of Lines Length of each line_.............. . ......... Tota! Length ..........................,.
<br /> 'D' Box ..........:. Type Filter Materia{ .......r_....... .Depth Filter Material
<br /> Distance to nearest; Well ......... '..... Foundation .......... ........... Property'.Line
<br /> '....M.i.•w•.'~".•,~ N.
<br /> SEEPAGE PIT ( I Depth .... ............... Diameter 4 `. Number ....
<br /> • , ..............
<br />• �-• . ...... ... ...: ........ .. ..... .... Rock Filiedd. Yes E3 No,O
<br /> Water Table_Depth........... ................_...L ......,..Rack Siie ..:' ..:..:....... .. .
<br /> 'Distance to nearest: Well ............................. ... ..Foundation Prop Etna
<br /> REPAIR/ADDITION(Prev. Sanitatlon'Permit�!►+ •per . .............. .... ....~
<br /> Septic Tank{Sp®cify Require nents� ....... . ._. .. .......:..:...............:....... ............ .. _ 5
<br /> Dis osoi Field fir.. :_ . /` .. .............
<br /> p ISpeci Requirements] - ... I..- ..;.
<br /> :..::--:•-•% 1 . . ` b./� (�_... -- ,,�s%: .v....:�' .. . ....... ... ... ..._,....... ...........
<br /> m
<br /> 1....•.•--:....• •..
<br /> 1 he (Draw existing and required addition on reverse side).".' ......... `.'.. ...+...
<br /> reby certify that I have prepared this•application-and that the work will be dare in accordance with +,Ian ,l"Reltt
<br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hsalfh District. Horne owner or 11cm
<br /> sed agents signature certifies the following:
<br /> "I certify that In the performance of tho work for which this permit Is Issued, I shall not employ any person in such me ueer
<br /> as to become sublect to Workman's CotrioreMation laws of California."
<br /> ,
<br /> Signed
<br /> ay�
<br /> coneByjitle ._
<br /> er.than-owned.
<br /> _
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY ------
<br /> .: ........ ..................................... 7f
<br /> DATE ... .-..1..............:........ .
<br /> .. ....:
<br /> BUILDING PERMIT ISSUED .......................................... .... ... : ...__DATE .-......--.,...:...... . _
<br /> ADDITIONAL COMMENTS . ................ . .............
<br /> -•-•--....... .......
<br /> ----..... ............ 77----
<br /> --------- ----- ------
<br /> . 1 _\+
<br /> _...-.»..............'........sem.,..-......_...:.. v ,
<br /> ....... ......... ....................... .............................
<br /> Pinel Inspection by: ` .........
<br /> y�:��. ..
<br /> .. -.. _..Ir.................................. /
<br /> - .........................................Date _. Z.�.. _ ...........
<br /> EH 13 .21 ..1-68 .. v, 5 ,/..._.. ..
<br /> S�i!'rl JOAQUIN LOCAL HEALTH DISTRICT ..- w ,8/7h 3M
<br />
|