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j FOR OFFICE USE, <br /> t.' ........... . ................. .... APPLICATION F'CR SANITATION PERMIT <br /> .......:,_........;..............._.._................ (Complete in Tdpllearol Peretti No. .7�.-.�`.. � <br /> 7 ..�........ <br /> #?. . . Tis Perml►6pken T Year freer Dale Issued Dots Icaled 6 �?..�/.:.7G <br /> ......................... <br /> i <br /> Application is hereby made to the San Joaquin local Health District for a permit to cons <br /> trkid and Install the work henM <br /> described.This opplkofktn b (imods in compliance with County Ordinance No. 519 and exlMlrq Rules and Regulations, <br /> J06 ADDRESS/LOCATION _.�4aJO. .....J.......�k1.. {i ... .. ,..�- [614 I. <br /> Owner's Nama �/ .d slff TRACT f...... .................. . <br /> t a ./F+�jVQ4$...C.`..��..I�i!.RC�t.rCCBkr.s ............ .............Phots.9. .R�..�.(.Si-7........... <br /> J a t ... ........ <br /> Address 5'...$.. . h�.1Rh'LtSBF[... ..... ... .. .:.........._City .. :... ...... ..... <br /> Contractor's NORM..A-.A-.0 1301'1lOK.:......................... .......�wnw i'3.s2�.�!1..9. ►hart ..59�i.3>.�iJ.C1. s <br /> installation will serve, ResWonce❑ApamMnf HoweJ],Cornmerciat fQ'Troiler Court 0 <br /> G <br /> ,i Moral❑Other...................................... ... <br /> Number of living un".. .� Nu <br /> i..... mber of bedrooms ......._...Go <br /> {: rbo,Te Grinder .. ......... lot lWt• ...................... ......_... i <br /> ' Water Supply, Public Svarotis and none ......._..........._.................... . ^,1 ❑ \j. <br /> 1 _.......... ......................... ❑ <br /> Character of soil to a bf 1 feet:. Sonci D Silt❑ aay ❑ Peat <br /> _'. ❑ Sandy loam Q coy Loom <br /> { HordPan❑ Adobe o FIII Mutes-lel .._ ....If yet,type....... <br /> (Mat plod, showing sM • lot, locjtion of system In relation to wells, buildings, etc. mud be placed an reveres, skM.l <br /> FIR1Y MfTAI LAT101rh septk tank or seepage <br /> it <br /> PACKAGE TREATMENT [ peg p Permitted 7f publk sevum Is available within 200 feer,l <br /> SE 'CI trAYK f J SM...............-.-- ...: -Uqukl Depth ........... :_..... <br /> y.�4�C7c2.... type C/ttcS1fltStMaterial- eieh. ..l1.T NO Compartments ..�...... <br /> '' DtsMtfo-to;tsarnt, WelI <br /> 7wn+e QZ2....Founduf:on..�3 �......... Prop.UM...�/ . <br /> tJACJ1ING UNE ( J No. of Ltrtf{j ............. . Length of each fine....6tSl...._ . Total Length <br /> '' <br /> 'D' Box . .,'.i-_'. Type fllter�Materlol ....................Depth Filter Material <br /> 4 <br /> Distance %npresh Wall j.. ...... .......... Foundation . ....... ........ . Property Line t`. <br /> SEEP PIT [ 1 Depth ...... Diameter Number .. ._ ................. Rock Filled Yes ❑ No <br /> -Wow Tabhi��Do ...._ <br /> ,•^ `. t 1^ ....................................Rock Site......................... - <br /> i Distc toe to Mareuh.Well . ................................. <br /> l . .Foundatk ....................xt <br /> ' Prep. UM ................ <br /> RBAIR/ADDITION(Prov. So Citation Petmit# ....._........................... t` <br /> .......... Date .................... ti <br /> Septic TankISpecifY.RlgakemenW—..._......... <br /> ............................._....................._..._...................... . <br /> E <br /> Disposal field (Spetlfy RequkmtMnkl .' RGrP.!-'E.l ........ X1�.:1-11✓.. -......5FTL>`....`T.H.f�l�.......................... :y <br /> S.P..S.lK._...Tlt�i�i:....:.LL).. TD....... .V.I.�RtN..E.....HY.!)L.Tt.fJt�l..:........-........Nle✓...... <br /> B.�f z <br /> d . - ........ ......_ ..__ --(Draw axisYng and required addlMon an novena,idol <br /> A1 hereby wtdy that 1 have Prepared this appUcation and that the work will be dem in accerdatce with fan Jeagttfs <br /> t Cwety Ordinances, Stale Lens, and Rules and Regulations of the San Joaquin Lead He" ObMd.Meaty eteemr er Ratti <br /> sed>♦enM signature cerNflee the fel owing: <br /> I "1 cewfy shot In " Performance of the work for which this permit Is Issued, I s.mll not emplcy any pensee In strd wtamtu <br /> as M ro�y/yorkman's Co P" ation laws of California." <br /> Signa`•J ...W.r... c JJ <br /> .... .. .. . ..... Owner <br /> By . <br /> ...... ... ......... .. ... title .. ...... . <br /> ' ' . -Ilf.ottter than owner) - - <br /> FOR DEPARTMENT USE ONLY _ <br /> APPLICATION ACCEPTED BYR.Q• _SNf1VL– / <br /> BUILDING PERMIT ISSUED .................. """ ......... DATE !o9 .7�7 _ _ ... <br /> . ... .. DATE .. <br /> ADDITIONAL COMMENTS................. . ... .._....... ....._. .. ......... .__ .... .... _.. <br /> ... . ............ .. .. _. . _. . <br /> ._.... _ ... _ . ........ . .. .... .. <br /> Final lnspechon by: ...._ _..... Dote . La. .. 3�r' 6 ;�. <br /> Elf 13 2L 1�0 Nov. $!{ SAN JOAQUIN LOCA EALTH DISTRICT <br /> 8/74 3f1 <br />