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�,y� ���h�.�K�•l+r''I �Y Iy ��rri��"IS.��+hK' - - f .�........ .. .- ... - ..>.� �.. � t-.-tX'a•+4 NYY
<br /> FOR OFFICE USESAPPLICATION FOR SANITATION PERMIT
<br /> _t Permit No. r.
<br /> • {Compieh in Triplftah) ,,p
<br /> Date Issued
<br /> v
<br /> This Permit Expires•1'Yea FromDate Issusd
<br /> x3
<br /> construct and
<br /> l the
<br /> AppUcation is hereby trade to the San Jaaq Eic„ with Countyt0 di ane No. 549 and existing Rules tand Requlotionnss—,
<br /> Z 'described This application is made 1n comp
<br /> t , T CENSUS TRACT
<br /> ......................... Phone� '.. �Q
<br /> Name I ti � AVI-W1�.-..... .City. ...... ��//♦�• ry
<br /> r Addrea .. s, ..... Phoma AM(
<br /> .1 S ..............
<br /> _. _. .. . ..... oiler
<br /> .. •� License •� ,;� ��- . '
<br /> .' Instolin ton will serva� Residence Apartment House 0 Commercial❑Tr E3
<br /> Court `
<br /> +tet r s Motel 0 Other.. ...................... f a?
<br /> Grinder
<br /> Gar .._........
<br /> baglot Size
<br /> Number of living units, �.. Number of bedrooms •• e , ,PH
<br /> f.
<br /> '3 FWater Supply, Public System and name ........................................................1aPeat[.... Sandy Loam p Clcry'Loam '
<br /> :Character of soil to a depth'of 3 feet: Sand❑ Sift Q Y ❑ '
<br /> y. s ...:.�. .{
<br /> F� Hardpan❑ Adobe Fill Material'............If yes,
<br /> (Plot plan,-'showing sEza of lot, location of system in relation to wells, buildings,.etc ,must be-placed on-teversesle'�!•�
<br /> �; ,
<br /> it ermined If public sewer Is available within 200 feet,y
<br /> NEVA INSTALLAT19Nt' " (No'septic tank or seepage p p :
<br /> rSize........................
<br /> PACKAGE TREATMENT f SEPTI,.TANK t I _.
<br /> n a »........
<br /> �4 {k t , r Capacity. .............. Type ... mp I,sn?s
<br /> Material NO ''yCo .
<br /> w .. a Line ; ....,7...:
<br /> Distance to nearest: Well .................
<br /> -
<br /> Four alio � � _
<br /> •-�
<br /> To wroo
<br /> �. Length of each!Nne :
<br /> gLEACFIitdG'LINE t l - h
<br /> Na of lines 9 !
<br /> 'D 'Box ...... Type Filter Material ....................
<br /> Dept 1 to`r= Materidl "�'�`
<br /> ,t fI :. r-1
<br /> ._.. l ......
<br /> ouFndation Wet
<br /> Distance to.nearest:
<br /> iPfopetty Ina s
<br /> RckFilled Yes Number ................Diameter
<br /> _',,"SEEPAGE'PTi I Depth ......
<br /> o
<br /> ---r��
<br /> r .•.�•n r s F + Water
<br /> k ............
<br /> ... Rock Size
<br /> Table Depth...............
<br /> ., Distorts to nearest: Welt ............... ...............
<br /> Faun dationProp Line
<br /> L.. ;;;•p- o t, .:...
<br /> ';;, �YF,�F REPS/e4p1Rti/eADDITION(Pr�ov.Saniation Permit ... ........... .--
<br /> ........
<br /> Date ..............
<br /> ......
<br /> ...............................r......
<br /> ..........Tank)Specify Requirements) . . r�, »
<br /> 1,,1
<br /> rM1✓ Disposal Fieyyld (S{ie'cify'Rr iremen/tat .:_.�..... i
<br /> lr',{fFr' i - ` ... .C.. ..._....... ..../Ow�•�Ii► �f,' ... Nom„ 'f -
<br /> = w 7 - _
<br /> . t v�
<br /> � i (Draw existing and required addition on reverse side)
<br /> �. t '.
<br /> "X ` '1 liarrsi preparwd this application and that the work will be dans in accerdsrnce with Sdn uie.
<br /> her Y certify that'
<br /> '� �'teenty`Ordin�anc �bte'Laws,-and Rules a�md Regulpllons of the San Joaquin Local Health Dishid Herne owner Or,�iMll-•, .
<br /> ", sn in ovsh inonner:,
<br /> +,used eQents rslgnaw�'eerMfiie the following-
<br /> "I esrtifl►then to fheyperfermanci of the work forwhichthis permit is Issued, 1 shall not airplay any pHs
<br /> k 1
<br /> -b ecenii suh(edyf-a',Werkman's Compensation laws of CallEornia.
<br /> 7
<br /> ,.�L�'�t y .f•gx'�ys,d' ....... Ow
<br /> net K -
<br /> F ...... .... ••_ 't 5 f S ittvl
<br /> „Fgned . n $
<br /> .... .... Title.........
<br /> By
<br /> a (tfx�Fielr t owner)
<br /> s`F x• r FOR DEPARTMENT
<br /> ONL
<br /> �i A 'lt--�..... D
<br /> ATE. /..�
<br /> APPLICATION ACCEPTED.BY DATE.
<br /> '
<br /> BUILDING PERMIT ISSUED .. .................... ..............�„/:......... .. ..
<br /> r: ADDITIONAL COMMENTS .............- .................. ......_.........:...................... . c
<br /> .............. ..................+L-,.......-................-. -
<br /> " ........:......................................... .......• .., ..............Date pv7
<br /> i
<br /> Final Inspaction b YN JOAC JIf4 L •tH iSTRICY
<br /> E.H. 9 1 68 Rev. 5M
<br /> } - iR "' • -.'tie"ti,ryh?❑,4;1tVACWA
<br /> a y rte. los - � �,A' r`•��
<br /> � ”+A 4 r y'4x i � ✓�':�o, �� 4�a•7 .:.+' -. '.sl,z 4�- s
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