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t iy <br /> V We <br /> IA <br /> FOR bFFICE USE. <br /> ..............: .....• <br /> y c 7 67 <br /> APPLICATION FOR SANITATION PERMIT <br /> . ................. ..... (Ce+npl�tein Trfplfeote) Permit No 71I''7!� s <br /> 4 I This Permit E%piss ! Yacr From Date Issued Date Issued ' <br /> r` Application it hereby mode to the San Joaquin Local Health Oistritt for a permit to construct and install the work <br /> described.T'nis application Is made in compliance with County Ordinance No. 549 and existingRvfes and R f; .. <br /> I`t - . <br /> egulatlortir <br /> J08 ADDRESSAOICATI ' li!?� - . s"` p* <br /> i ..CENSUS TRACT .. <br /> � s <br /> ;G: <br /> Owner's Name :h . .Phonei'~f� } <br /> i Address 1� �� ��. `.. .., City.... t <br /> 4 ........ tr <br /> I Ccn 's Name'! ....... se tlF. '3..y3.... popdd. bQ ' <br /> tactor icon <br /> Inssallotion will serve: Residence Apartment House Commercial[]Trailer Court f>- 1------------P <br /> P <br /> Mote![]Other .. .. . . ...--.---•._... <br /> is Number o' living tlinitss.. .!..... Number of bedrooms ...��-. .Garbage Grinder . .. .... . Lot SiteRWater Supplyr Public System and name ..... rivy .. S <br /> Character of soll to a depth of 3 feel: Sand Sitr[� Clay Peat❑ Sandy%pe <br /> ►r'] Cl Loam C] <br /> Hardpan Adobe Fill Material .... ....... If ....... <br /> Y9 }} <br /> {` IPlat planshowinq. size of lot,,fpcation of system in relation to wells, bufdi�gs, atc n•vst tie placed on reveta��sldat� <br /> }; ;.N9W INSTALLATION: (No septic t k �,-Kepage pit per if public. sewej is available wit"iU 20:'fc I . Q�^ <br /> �11. <br /> a i t PACKAGE TREATMMT ( I :iEPTIC TA C e...... . . . ...... .. . .............. . 1.14oid Depth► , . <br /> S, �".It � � <br /> Capac1;y//vvg� r- ..�--. Mr3terEa#...( stC�.. No.to`m, <br /> partments 'L �r <br /> Y—ij�tJ , <br /> Distonce IgV,4p est: V�lel .� �... . ..'".'""Fou��ttii —'7'`d' Prop.'Llne <br /> it <br /> LEACHING LlEVf [`� No. of Lines��l .Or .. . -,�on f eti line .. �.... ength <br /> 'D' Batik." +Ty�el F S+ICt�ria .. ;Depth"Fi#terj M i I ....�.�..�. f � � <br /> Distance�b ne?r4 WV 3'.i..... ..... Fount! t�"o'n� ., Property <br /> SEEPAGE PIT .,� Depth, .�3�`, .�. Di r �.:.. Number ..:..... Dila Filled Yes f�o <br /> e .... .. �r i/ Y <br /> a Y o <br /> rr *� Water.Table Depth _...._. :a <br /> ` k Si w <br /> Distance to nearest. Well �. r .................... undatfon �/ `Prop <br /> , � jam:• .,y+;.. ,M- ; •. -.. <br /> �$ REPAIR/ADDITION(Prev. Sanitation Permit ........ ............. . to ........... ........... 6 t <br /> s5e •�c Ton#c Re uirements ...... ..... .....�.. ..... �t..................... <br /> f .Fv ISpec fY q t !.-f(5 Y <br /> Disposol Field .(Specify Requirements <br /> .......��} �� ... <br /> t. '"��+3; a� -:;, _ ►(c"�thaP %iifitttd r8 Jiredtditian verse side) rytw",}y-twi <br /> t� 1-hereby tarlify that i havegared this-appi[ication�and_lb�e_tl� woriF-vriii4-ire-done-M�atcoedance with San Joogn#e N <br /> M.,Ceun#jr CWlnan s;.State s, and Rules .and Rogulatiens'ef tho San Joaquin Local Jfoalth:-Dis'kct �aniitv. <br /> er EiiptiP R s <br /> k -` - L t'� <br /> . sad agen �atgn r0`tertiF}'rs thi following: .,r } 'Vi ce+tify thatinri�irr�anct.of tise work for which osis p enr:it is €ssued, 1 Lho#i nal �aipicy any p rson 6n <br /> nro'sub Eli to �rkrr`an's Coir:persation laws of California:' <br /> f Y o[ <br /> O ............................... ...... Owner : <br /> I r��h <br /> 1 oth han ow:ger <br /> F � <br /> sr FOR DEf►11RT ENT�Ui NLY <br /> APPLICATICN ACCEPTED BY. . <br /> ,� •. ...-.. RATE ...�.�.- ,. ... .....% y� `� <br /> BUILDING .IERMIT ISSUED. ._ ... ..... . _ , DATE. .................. <br /> ADDITIONAL-LOOM;NTS ......... ......................................... . ..... ...:... .. ., <br /> til . .......................... ................ .. ... .......................... ... ....... <br /> :... <br /> ;� t <br /> Ficial Inspection by: ..M: /j ✓?l�s'+"[�?,'�. t7atefr-�r-` ./...:::..:...... A <br /> r.f <br /> SAN JOAQU!N LOCAL HEALTH.• DISTRICT. _ <br /> E.H.13 24 l•168 Rem' S,1A _ :f 7/72 3 H ,. <br /> iii y'"' F £{ �—•g3g4FV"`"Yb :'y.•wh"vyi `.R}s,.J `;J ��..s�3•�`: t-•''r{�s.A' <br /> �- <br /> `,n�`t �.+� - _ a-J�..-4- 1 3 ':Gat - •. <br /> .hot �4 <br />