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<br /> APPLICATION FOR SANITATION KIRMIT
<br /> T
<br /> .................... (Complote In Triplicate) Perm No. .._. 75�•
<br /> This Pe
<br /> r rmit Expires 1 Year From Date Issued Date Issued .. F
<br /> Application is hereby made to;the San Joaquin local Health District for ermlt t
<br /> described This application is mad b in compliant® with County Ordinance No• i
<br /> tr,(. p a construct and install the work,her
<br /> $.J08 ADDRESS/LOCATION _ 5. �lCf754 eSs��Rules and Regulations:
<br /> Owner's No' 6- .., � ..• s...... ....................�.. .�..CENSUS TRACT #
<br /> . r.. y :ram :......,,.° y'
<br /> +ofd ess ".a.. r{..«. . Phanf3 . .................
<br /> e .... . Cit
<br /> ri Contractor's Name -F `rs•t y g
<br /> -Ins ttrll
<br /> Ice
<br /> atlon wil! seA! : , c.Residence{ `Ap L nse � Phan: + 47
<br /> artment ..
<br /> v Mous ,
<br /> „ mmerc a Moller
<br /> `Motel(�Other a Co i l []Tra Court
<br /> Number•of;-llving,.units:-....::.......' N :...
<br /> ...
<br /> ti
<br /> Number of bedrooms _---
<br /> Water SupplY: Public
<br /> System I " •'G Gr
<br /> arbage
<br /> Y and name Grinder Lf Size ._
<br /> iCharattsr of sail to a depth of 3 #esti . ,.... ..........................._._-.., . -• . ...._.. - �._:.._ Private...
<br /> Sand Silt I
<br /> 1: Clay Peat❑ , Sandy loam El
<br /> Hardpan I] Clay Loam ,. g
<br /> }s Fill Material .
<br /> Adob®
<br /> (Plot pion sllowin size I l: System In rerati yes, pe ....... ...... a.
<br /># If
<br /> g Izo of lot., location„oT:
<br /> ya
<br /> NEIN IN5TALLA;Epiy; . .,(No septic t ank yr see o' it` rmi oto wells, bwldings, etc.. must be placed an reverse side.,.
<br /> F ,:
<br /> PACKAGE TREAtMENT [ ] i` p l .,, Ifipu llc sOwvr is available within 200 feet,) f t ,
<br /> SEP `i� � ..............
<br /> SEPTIC TIC TANK S' e.
<br /> a Capacity 1� ;' a T fLiquid Depi .............
<br /> Ypo ........... Mcsteriar._ Wo..
<br /> Y ' {Distance to nemrest: yVm
<br /> rr .......
<br /> ts
<br /> LEACHIN�'Lllrl `..No: of fines�.. �"�` ot�on ......_f sr . °Qmportp eine _
<br /> E Length of each llneFou � .._..-•- Pro n:
<br /> g �.r ............... Total Length . . ,}
<br /> j ox '.._.... Pi'filter Material ------------------ 9
<br /> s, .� Distance to nearest: - ..... . ..
<br /> Depth. Finer Material �� a { !
<br /> ' EPAG E`'PlT Wsll _...._.
<br /> .......... Foundation ... _ ,� . �... _ Pr r #
<br /> ' Depth, ._.. .. .•- Di , . '. Property..Line ..:.. 4 .N
<br /> Tobi , e th ..meter .. ... Number . . ..._ ' Rock Filled., es. .N
<br /> Water e D ) ci, Y o Q
<br /> s .p ........ ............... ........„_.Rock Sig ;, r __ s.
<br /> r , 'DiI<tanc@ to' /tfBar85tf W ..................... @ ..!
<br /> PAIR hD' all .... tl r '
<br /> Fou on �”
<br /> s / AiTiON(Previ Sanitotion,.Pfsrmit 56t . Prop. line .�...... .... '.
<br /> Septic Tdnk $ ---... ............ Date .._. .... I
<br /> ( Peclfy Requlremenfs)JJ+ ._...----- - r• J d: ;.
<br /> x,. 1-! _
<br /> -----
<br /> ,sposal Field r ,. ---••----•••• ........................................
<br /> ........ ... ........... -- - F
<br /> 5 ecr '
<br /> l P fy Requirements) ............:. . _.....
<br /> r , __ -
<br /> -----•---.
<br /> 4
<br /> ------------------------ ----
<br /> _.-............ .......................
<br /> {D✓�w existing and required addition art revers® side)
<br /> I hereby certify that 1 have prepored:Ithis application find that the work will bo don® in etre
<br /> taiaq ,drdir dnees;`Stote.laaws, and Rider. and Regulations of the San Joaquin Local Health, District. HoItI
<br /> rdance with San Jaaqulnl
<br />;t sed'agents "signature certifies the following: a owner or liceiH, r
<br /> "i'cerhfy that In the performance of the work for which this permit is issued, 1 shall not employ any person in,lsucH
<br /> as'to become suiisjeet.to Workman's Colnpenf:atigla 11awla of California.”
<br /> manner
<br />�rS,9ned � r
<br /> ------ ........................... ••
<br /> gy a ;y Owner
<br /> r ..
<br /> of than ' Title . - -� R
<br /> owner)
<br /> {'
<br /> DEPART ANT uSIE ONLY r
<br />.BUILDING'-PERMIT
<br /> A�PLI G P
<br /> IN SS
<br /> UED I
<br /> E T:i ' / /
<br /> ADDITION
<br /> A. COMIU{ENTS �F -- ._
<br /> --r�-..u.�-- DATE .�r�`_.,T...Z:.�,�� I
<br /> .......... .............. DATE .............
<br /> .... _ �.
<br /> __ .^. .. ._........ '........
<br /> 1 ....
<br /> ...............
<br /> ..................
<br /> .- ...... ................. .._................,..-----._..._..._.__..._._...."Y...........
<br /> . .........._........ rl.
<br /> _ ..................
<br /> Final p l --- -_..._ ..... ?
<br /> ins ect�on by I
<br /> ... .. . _ _
<br /> • ... .. .Date .. �.��-.
<br /> SAN JOAQtJINqL HEAL `
<br /> 11 ill .J n " ,
<br />
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