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FOR OFFICE USE:
<br /> APPLICATION ICOR SANITATION PERMIT
<br /> .......... .....-••-•.........................•---...
<br /> ._ ., �...�..._„. (Complete in Triplicate)�,..� Permit No. .......... .........
<br /> This Penriit i?xpl s 1 Ysar(rent Date bitted : e
<br /> ............F .. i .... .. .. ....:. ... Date
<br /> Applkatlon'i's hereby i iade to?the San Joaquin-Local f-ledlth D strict fora ermi }
<br /> p t to construct and install the work'herein
<br /> described: This application is made inrcompliance-witH County.Ordinance No, 549,:and-existing Rules cind Regulations.
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<br /> }OB.ADDRf55/LOCATION',.... _
<br /> ...... ... . .......
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<br /> 'a....CENSUS RACT .....................
<br /> Owner's Name__----- _ -- ! .Phone
<br /> Address . ] ,5���.._��� 4 � � I �: =�ty
<br /> dLx „�.:sa+}•-u. r..w ...:.Y. .^ir.�^.+w[ J<y„-- i ; _ .. ..•••••%'3. - ............------,-------
<br /> Contractor's Name _ J Cp
<br /> �'.:.Liosnse# ...
<br /> Phone
<br /> installation will server �' i' � • ` `
<br /> � F ', Residence Apartment House 0 Commercial OTrailer Courts
<br />' ..�_, ,�� .�- � .s. .t : .•� ,
<br /> at �_ �: ,� .i:.� F _s ._ ' -_,. '��.
<br /> Number of diving units .::U;.: Number of:bedtoorns"J_J.__Girbage'Grinder :.._.::... Lot Size
<br /> 1A1 s s r i 1
<br /> r x i
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<br /> Water Supply:-Public System and name----------- .. _ p .. _......... . ,1 .. !
<br /> .Private !
<br /> Character of soil to a depth of 3 feet: E]Sand ` Silt 0 +Clayt 0 Peat 0 Sandy Loam Clay Loam 0 ,
<br /> .4 Hardpan.0:. Adobe 0 Fill Material ............ lf,yes;type............... z ........
<br /> (Plot-plan,-showing size ,of lot, location of system in relat€on`to wells, buildir� e, , '
<br /> ! I g ete: iriust be placed on reverse side.('
<br /> NEW(NSTALLATEON: 4 (No septic tank or seepagepit permitted if,public sewer is avoilable`witfiln 200 feet,)
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<br /> PACKAGE TREATMENT, SEPTIC TANK r
<br />- � x � ,� , k -- .................. L-aqui ep --..._....-•-•- - -
<br /> i .. y Ca acs s ....
<br /> Type............. Material. y , .._ . m _.... �
<br /> E _ ---
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<br /> 1- Distance t1i nearest: Well ..... ou o.� Line # j
<br /> arf e
<br /> a n
<br /> t-< nd tia lmp nts•
<br /> LEACHING LINE [ �. No. of Lines x -__ - Ling line._..
<br /> rop.
<br /> ' th of each I Total Length ..
<br /> € I i?' Box -----------
<br /> . -- .Type Alter,Material De th F:Iter Material 9 ..
<br /> ,. Distance to nearest Well % t•... Foundation �..:._ .' Property Line .._. '. .
<br /> AGE PIT '.(.! _ .. (: 1 t f:
<br /> SEE � Depth .......... Diameter -- __ _ Number ............ ..... Rock Filled Yes 13 No 0
<br /> Water _able D`eptltA" -----------"
<br /> _. .,: __ __Rack Size ................................r
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<br /> � - Distance to:nearest:;Well b .l_ ,,�..:. `_-- u da o .. .. i p ne ......... I
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<br /> 4 i ;0 ;t l P`a l
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<br /> / ION:(Prev. Sanitation. Permit qls
<br /> ....._.::.._._---� -•••---- ----�---•--; ate ------- -------
<br /> REl'Alli ADDIT ] ' --�-
<br /> .Septic Taitk'(Specify,Requirements] -:- 1 .... .... F s
<br /> `•----•-----••...... ---• _
<br /> Disposal field. .(Specify ,'Req.uirementx]- . = `'(J " �•�— N
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<br /> �.�«-. •a .... _ v—. a y- _Y„•'� i
<br /> ” " t" "" "�' ;' "y- „°' {[)raw existing and required dddition'an reverse side)!' - r i f
<br /> I%`-hereby certify.that 1 have prepared.this application rand,that',the.work,.gill be done in s dtcordanee•,with San Joaquin
<br /> County Ordinances, State Laws, and Rales and RegaEations`of tfie San Joaquin ,Lecal Heali iDistrict'Home owner or,lien.
<br /> sed agents signature certifies the following: i.
<br /> "l certify that in the performance of the wefk for'which this permit is issued,I shall not employ any person in such nionner
<br /> as to become subject to Workman's*Compensation lawsPof California." I. l f j € i
<br /> Signed - ----------
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<br /> .�ir.a
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<br /> BY - I
<br /> Owner
<br /> -------- ---
<br /> x tle .................. r
<br /> if other t i
<br /> a. .j. ;,a •i+. .Y � i
<br /> • � -� -•l. than. .- '_ -_ a
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<br /> _ MR ONLY. <......� A. �
<br /> APPLICATION.-'ACCEPTED BY ...--- -_- - i t �, l 1 D /"�� a t
<br /> - ------- ------- ATE S .._,
<br /> BUILDING`'PERMIT'ISSUED -
<br /> ..:-.-'.._._--•-.• �
<br /> - --•------•----- '------ .................•-----.--_.•------•-••_.._....•----------...-----•--••- ----.... ----------•'--.......................
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<br /> ------------------------- ------- ..............•'•--------------•--•--- -------- .............................. ............ t
<br /> - -- - • -----•- ----- .-----•-
<br /> Final Inspection by: .. -- -- --•---- • -- . _---- ------------------------------------Date .... .`J
<br /> � 13 21.t 1-68 1�• 5M SAN J©AQUlN. LOCAL HEALTH D1STRlCT 874 3M I
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