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?O I iComploto in Tdplica»1 7/_/a Sf <br /> Do"Issued i <br /> s permit Eepim I year T+om Date Issued *M000 t <br /> mit to const,,I and install the work hetaln <br /> s, uin local Heolrh Distrix far a Pe s' <br /> Application is hereby mace to I"S..n Joaq with('amtY Ordinance No. 549 and e><istiMl Rules and Regulation <br /> d^xribed This application " ma" in compliants. / TRACT _ _....._..... <br /> -�) G•l .��-!' [ `! _ CENSUS ... .--- <br /> JOB ADDPESS%IQCATION / -. . /. �yi' Phone y- - -- ♦• <br /> AtL <br /> Owner's Name •ECl'`S[w (.%7:C7�2.;/. <br /> y+ !/� <� •, .. ,. i hone <br /> Addts!ts License d, . <br /> Corttroctar's Name 4s Commercial roller Court Q <br /> Residence Q Apartment Howse❑ <br /> Installation will swvs: /':u; z <br /> Motel Q Other it <br /> Number of bodrooms . ......Garbage Winder <br /> Lot Size .___. .---. ...... <br /> Number of living unix: .._ _. .. ....... ......PrivMsv, <br /> ._S If s .. <br /> Water Supply, public System and name � Silt Cloy Q Peat❑ Sandy loam ❑ Cloy Loom <br /> Character of sod to a depth of 3 feet: Sand Q Q . . . <br /> i•lardpon❑ Adobe Fiji Material s _ Ye •NPe !g <br /> -- - - - - - - arc. must be placed an reverse side.) <br /> IPlot plan, showing size of lot, locution of Sysco i f relation eJ°f publicseweris available within 200 feet,) <br /> NEW RE9ALLAU N: (No septic tank or seepageP pe <br /> , . Liquid Depth ._ ------...---._._--.-- <br /> - <br /> ] SEPTICTANKSize_. _ <br /> PACKAGE No. Compartments <br /> Capacity Type MateriryOIt <br /> .Foundation .. ... Prop.line-------------..... <br /> ----- <br /> Distance to nearest: We - . .. Total Length __......._.._......_... <br /> No. of Lines Length of each line <br /> LEACHING LINE [ � - -"-""- _ <br /> ,__Depth Filter Material -. - - <br /> .D• Bos Type filter Material .---�- - Property lineDistanceFoundation .............�--��� <br /> - <br /> - . . <br /> Distance to neo.est: Well . Rack Filled Yes Q No Q <br /> Depth Dioceler Numbe• <br /> SEEPAGE PIT ( I � Rock Size - <br /> Water Table Cepth _. _.. . Prop, line ........_...... <br /> ..... <br /> Foundation <br /> Distance to nearest:Well - - - -- pot _ _ )• <br /> REfA1R/ADDITION{Prey.Sanitation Permit . .. . <br /> j�G.., r Z f��:• ��i•.l •T <br /> Septic Tank ISpecify Requirements) - - <br /> �f R uvemen I L-,.'s t�C....+ c�..r ! . . <br /> Di pass) Field (SPcc' Y eq ,.y.J/-• ". _ .-[-i-t// .. .. ... . <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 have Prepared this application and that the work will be done It accer ct-H with Saw Joaquin <br /> County Ordinances, Stare laws, and Rules and Regulati Ins of :he Son Joaquin tocol Health District-Nome owner er Ilceo- <br /> ermit is issued, I shell net employ arty Person to awh manner <br /> sed o9r.»signature certifies t+'*lollowing: <br /> "1 ramify that in the Performance of the work for which this p <br /> m to became ) <br /> subieq to W*rliman's Cempsotion laws o <br /> enCalifomiaO„•+cr <br /> By If o-he than own -'-/r �- <br /> i ! - _ <br /> ( e'l / <br /> FOR DEPARTMENT USE ONLY -7, j•GFJ7 ' <br /> APPLICATION ACCEPTED By - - <br /> BUILD'NG PERMIT ISSUED <br /> � <br /> DATE <br /> NTS ,e-• S � C. Zr. [ti`V-1ti• <br /> tt'' `•moi.-�.t <br /> ADDIiIONAI COMM j1 _�•.�, 11 ',,.v,i,,i-.1J. • �' .. _. .. <br /> lti S^7.yJ/ t . Dore <br /> Final Inspection by: <br /> SAN JOAGUIN LOCAL HEALTH DISTRICT <br /> E H 9 1•'68 Nev. SM <br />