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FCR OFFICE USE:
<br /> ' APPLICATION FOR SANITATION PERMIT
<br /> r„ {Can+pkts in Tripliteita] �", . �/
<br /> •ars ��a. �•-� r� - '.�. '»- i ., �-
<br /> + I Date
<br /> k,•,�. ' h>'enti tei:xpiras 1 Year Rom Dow Issued -
<br /> a y -;
<br /> Application iso hereby made to the San!Joaquin'local Health Distnctr for t a permit to construd;.and install the work here`in
<br /> described This applicdtiori:is-ir►ada .incomplsance with. Coutityi`Otdinance Na. 549 and existtn90 Rules and Regulations.
<br /> CENSUS TRACT
<br /> ; G
<br /> JOB ADDRESS/LOCATiO , 3 '
<br /> s i e .Phone
<br /> Owner's Name._-}_ - • i..............................._
<br /> ` .. ........ .................
<br /> Address --� . .
<br /> .., 3 .,: y ,,p a
<br /> Contractor's Name _ _Lraiia�sst - ° ................_
<br /> al ;
<br /> Installation' will serve Reis e6
<br /> Apartment Hausa fl.,Cornmerca ' pfrailerCcurt �,
<br /> I: .}, n... :.. F, Motel ❑Qther .. I 3 ``- ,
<br /> iF. r i^Ind _...__ 1 ..
<br /> Number of living uni#s:.... _-.. Number of bedrooms Garbage Gr er Lot Sire t'
<br /> _
<br /> t } 1
<br /> %kciter Suprily Public Sys-iitem and name . t--� - ...
<br /> r Charac#er of sail toa depth of 3`feet�" Sand'Q Silt Q; Clay 0 Peat Q Sandy Loam Clay foam❑ ,,,...
<br /> Hardpan[} ,Ado�e..Q' FH 'Material 1#yes,type. ,_. Q[
<br /> (plot'°plan sKo ving
<br /> silo of. lot, location of£system lin relation to- wells,ybuildings, etc. must-be .placed fan everso side.!
<br /> 1 WEW 1NSTAL'LA'` 110' b '{Na septic tank seepage pit permitted if publk sewer is available within 2Qd feet,#, `-�A
<br /> g a 3 F ,
<br /> PACKAGE TRI=ATMENT ( ] SEPTIC TANK j,„A $ ;r Size ' .. Uquld Depth . .. g.`
<br /> .. . i, ,-. • Capacity ` TVIX, $$N Materia! .} 0 No. Compartments i.................. i
<br /> ` ► a
<br /> s s ti• Ii : Prup. Linerc ._...._._ ._-W ! FouwidatA Distance 4onearest# �.
<br /> t ch;
<br /> L{EACHING l INE [ ] No.i of..Line' -- .. i J Lene
<br /> gth-',,of aline # .. E. k.'Total Length '.....t---• .. •• }
<br /> ' _ ! 'D' Box T e,:F�lter liActterial” ._ :� _ i .. {Depth 1 alter' Material ... .=-a' --=
<br /> l a _ yp a• i
<br /> ' 'Distance to nearest Weil ' 'dF n
<br /> t , s ' ou dello 1_.__..{......_--- Property. Lin
<br /> ...,..,. i :.. " , Number l . I ? Rocky Filled ;Yes'Q 3' No
<br /> SEEPAGE PIT Depth Diameter k z
<br /> t1
<br /> Water Table`Depth .. i r i...- -Rao Size r
<br /> F
<br /> _
<br /> `bistarice;to nearest: Well z 4 .Pour dot€on Pro Line ,
<br /> 1 -•r.- n 2 •.may_ .w�r.....v4.,
<br /> REPAIR/ADDITION(Frew Sanitation'Permit s P . M. r ;4. Date 9y}..... 4
<br /> ^� 1, ; ' --• r .. AWIt..w,rbar�,N } •• Wt ,Mr, _ ...p-1•r`•_ { ._-_i• > w•• *4.•..-..'.-. •.........- _•o
<br /> Ir Septic Tank ISpeafy Requirements, ""
<br /> Disposal.:'rFieId,:jSpecify-•Requiilementsl � -' - •--- , i w !a t.
<br /> - I_ �.:_ ��ti ' ry -t dxa -.A: � ./. ••F,•_• n=ot
<br /> ' � 4
<br /> „• +1 ff to (( p aye
<br /> E 9.
<br /> ................
<br /> x - { - -e i • r!L i a. . r.. ..
<br /> •-'- ---•
<br /> I[3raw existing andt required additidfn^oni reverse side)
<br /> } E' `.n Ah»t: .. A 4Ytr,n*'1,.>s F .M c] ,ia.t...4+' b.F'.•C?i. M
<br /> r I hereby certify,!thatt1-have`preptlia'Alli application and'that the work, will be done in accordance with San Joaquin
<br /> County Ordinances, State Lows,.,.and Rulis,arid'Reguiations of #ha San'°Joaqula Local"Heaitli.Dis#ricF Home a>wnet or iitets-
<br /> sed-agents signature.'certifies 4he iolla hying. € .aa�tr a+� "'r <,,. . •r= „r.saa •r a r=.a= ,> . ."'
<br /> P "1 certify-that in.the performm ibnce of°t `@ worii��.or srhlrh this permit is issued, I:shall not employ any person in suth manner,
<br /> as fo beiome subject to Workman's: mpensation,laws•of:California
<br /> y
<br /> ' 1 I !Owner •.. t l r
<br /> Sr ned - ---- ••. - -- -- y
<br /> { ; R ? �_ Title., .. „i..
<br /> By
<br /> f ' - -• lif other than`owrierl it § , „.» . y ..a,. 4-..
<br /> e '•, w .„�i .. .n,�a ..aw.. ..k,� P '--j-:FO "OEPARTMENT'US
<br /> � ” a $ � � � apvf�� �n,'r�°�"saPz�,a�'9'r„ ,e.+.r�•�,
<br /> APPPLICA" 0 ACCEPTED,�BY ,. "_'��� :_.. �4c ----- -------------------------------------- DATE
<br /> BUDDING PERMIT ISSUED ..--... pATE ..-'
<br /> AD61TIONAL COMMENTS ---------------- •---...-..._--.. .......
<br /> s` -•-------_---- --• --------- --------•--••••••-•------------ -------- -------------------- ----. ------------•------ --•--•------ .........................
<br /> - -'
<br /> Inspection b -.-.--..Date
<br /> Final Ins .. .- ./ ...
<br /> p y: "
<br /> Eli 13 2b 1-68 ltev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M
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