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FOR OFFICE USE..
<br /> 'APPLICATION IFOR SANITATION PERMIT
<br /> : .tCampkte:#n:Trlpl#tata� °= -`; Perrriit:No.-4*76� 3...5
<br /> . " i ... . a i3riiiit E
<br /> i Th1s P xpires 1 Year.iro`en'�ohlsitaed
<br /> APptitatiori-isElt�ere Y � } LFie an 4,.�,. ,,•ti a .l„ z .,� � ,�.,. .k .a....,.�,. ��...�.,-, .$.... .�;.,..,,�,•. , -;,_,..-,�. �... -'3-
<br /> b made tot Joaquin Local Health Dtstrict;for,a permit to:.construit and install .the work herein
<br /> described:.This application.is,_made.in tornpiiance-With'-County.Ordinarice No.--549 6nd4k1'sfiri Rules and RegulQtians:
<br /> OB ADDRESS%i.00AT�4N L7 } r 4: .,,,,.., ... i g' t• ,•..
<br /> €. -• .... . ..CENSUS TRACY
<br /> Owners„Name. - 11 :i f. '. i j E ;
<br /> { I .,...,, .i ;
<br /> le i i k Phone .
<br /> $ .: r, s
<br /> A
<br /> Contract { i .•.... _.. ty 4 ...................w
<br /> ar,s Mame 4
<br /> —4. :LEc�ense Phone
<br /> tnstatidt�on w�li serve i ' Residence[` i
<br /> t 3, Apartment House 1] Commercial railer Court,', i
<br /> e ;, f_ - _ e
<br /> NuEsber of ii�rng units, 3,,,f>• Numbee of be ; v �.. : { .
<br /> 3 a ,j_ s I t drooms G&bage Grinner ; r . lot Size
<br /> Water 5vpply Public'System and name': _ _
<br /> Character of soil to a-depth of Veeti Scthrf ilf .sl # - , 4 + P .Private
<br /> b .E 0 �`Ca Pett
<br /> Y.Gl i o Sandy Loam 0 ; Clay Loam
<br /> i $ - Fi�r partIE 0 'Fill MonelloI ,If e 4 i i ,... • .,.._
<br /> a a Stem in ¢ Y s,f YRe.....a ....E :.
<br /> s..
<br /> {Plot plan 'showing size of ioti'10 otio y ” retell
<br /> on o webs,°buildings, etc. Must be= ptdcedk on reverse,`1 e\ l
<br /> NEW lNSTALLATlON: {N septic t nil o` ti .4fe5 f < , � . ;. � M..,IE, ,t . l :. �' ,_ ,,. .. I
<br /> PAC GE YREATMENT } ►/�y/seep`age�plt permitted�i/#/3J�pjJubl public sewer is a l ilable Within 200 feet,}
<br /> i ( ] SEPTiC TANK j`A `:4kxH E s� �'. ... . .....................k
<br /> i _ i 1. i ! ;Liquid Depth .......
<br /> ! _.. `
<br /> $ .. capauty _f �;�.,_,,.TYPe �__ Matetdt k :.a. Y i. t ' W
<br /> r Na. E Compartments se ...........
<br /> .
<br /> Distance,:#o,nedresi, Well,t _ ,rte-- Prop.# 4.
<br /> u. . undatian R_..
<br /> LEACHING LINE Plo. ofy ,nes S ,Lerigth.'of Line D
<br /> r l F l p each' Tota! Length --------
<br /> ' l 'V IBox� = .!Type Fitter`Material .. D i.. { k . ...
<br /> tDistance to nearest Welil - � Foundationit
<br /> s 5 h FiIter Materi I .` a .... ;Z
<br />} S EpAGE PIT}' ri� Depth /,� , ; ,� �� i � ... pro
<br /> Party-Lt�e ✓`-t' ...w .
<br /> P c". Oiameter
<br /> a gF p .,� ...4 v N_um-betr, 1rn Y
<br /> i •• Rock Yes oWater TabteDePth -__ l r ock
<br /> t r
<br /> Size Z .
<br /> istancei to nearest: Welt; 1� Founda ion
<br /> p1TEONrev
<br /> ( Sari}lotionPermit ► C/ �°/^=T- Prop. Line /�
<br /> gEPAIR/ADP .......
<br /> < sy`= F
<br /> } r #.
<br /> c
<br /> Septic Tank (Spec;fy Require etas}
<br /> a. y. ;
<br /> I ..;,. -
<br /> ............................ ..................
<br /> .. .._ .. ¢ I ( ..
<br /> Disposal,y Field.(Specify. Requirements)'; . `�,.� i t t
<br /> y pp
<br /> g 3
<br /> e r. :._ . -. .. yy--------------------------------------
<br /> _ _ _ .
<br /> 3
<br /> t r
<br /> 3
<br /> {Draw existing and required addition an reverse sidej t i t r
<br /> I h reby cer#ify that I have prepared this'appllsatton""itiid`thatttie`Ywo"rk" wiEl"be done # ` " A t w
<br /> .,,, ....
<br /> £ # in accordance with iSan AJoaquil i
<br /> r County Ordinances,,State Laws,and,Rules a6d,Regulationsa+f 1116 San.JoaquinAicalMedlth.Disirld. Henle owner or Iicen-
<br /> sed:agents signgture'tertifies-.the foilaw-,in t d fi
<br /> # ,
<br /> "1 certify sheet-in'the`periormpnce of the wor&foir,wh€cis thEs en;ni�is 9asu "I s#�.II n t >•jd.�`a.i .,..,....., ...., ,.-.i-,.
<br /> as to become sub ecf to W `
<br /> i p ; ' s P Y Y person In such manne►
<br /> �1 orkm s Compensation laws:of California
<br /> Sigged FI t _ 1 i i /��
<br /> By l t a $ ,. E R y ner . r
<br /> �/�/
<br />� �- -- � - � - l ill -- ' .,.,. ,,, 4-
<br /> (If,ather than owner! �a ,• - ,�.,. ��,:,.. �. - ..# p
<br /> ,,royu..
<br /> y,lu,w..'H',-}w•M•` -w - .w ,•s4 1 $ i. .4�. ` •-..,•; V.. . ..t
<br /> R-., PARTMSNTIUSE. ONLY..,..». fl,......�,: i .....i[
<br /> APi?LICATEON,.ACtvE.PTED BY a , ., ,. a
<br /> t
<br /> i Blit DING PERMIT ISSEIED DATE : - . Zf-----
<br /> •---
<br /> ................... DATE _....`....-....
<br /> AD,ITiONAL COMMENTS --------------------- ,--.._ ------------
<br /> .......• .
<br /> --------------.-...............• --
<br /> ----------------------------------------------
<br /> --...-----•-------------•----••---..-------- --.----------------------
<br /> Final inspection by- ------------ --
<br /> -.._ ..--•--- ---• •--•--•--------•--•---------•-----••.............•-....-.--.......:.-------Date -.. .- ------ --•-
<br /> EH 13 2h 1--68 Rev. � ------
<br /> A JOAQUIN LOCAL HEALTH DISTRICT 874 3M `
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