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IFOR OFFICE USE <br /> 1 APPLICATION FOR SANITATION PERMIT <br /> Permit No.,? <br /> ' (Cempielrin Tri}NceNl <br /> 1 This Pitanir Expires t Year From Deft Issued Dare lisued , ' 1%-.71 <br /> Application is hereby made to the San Joaquin Local Health Ditrr ct nor a Per mar to construct and instal' the work herein <br /> described This opphC~ Is mode in eompiwrue w'th C Ordinance No. Sag c,+d exis•,ng Rules and Regulation <br /> 1 `p 7R I CENSUS TRACT <br /> JOB ADDRESS/IOCAyQN(� <br /> t �fd� <br /> Owners Name / .. ..__ �y�y'c -7 Phone <br /> Addeess J } Gs ��^ e� <br /> Contractor's Nome (0ofPL--4?-su x /� � Lkonse A mono <br /> one <br /> Installation will carve: 91 pdon a WApartment Houss o eommercial'TTra•for Court [ <br /> Marel ❑Other <br /> stern and none . . . �.... <br /> Water Supply Public 5 <br /> Number of I,Ing unit�.....1. Number of bedroorns Garbage, Gritdat Lot Sia ��_ . -_..... . _...Privoto <br /> ro <br /> t <br /> Chmoctar of soil to o depth of 3 feet_ Sand 12 Silt 0 Clay Peat C, Sandy toam C-) ry Loom <br /> C* 1'] <br /> ` Hardpan [ Adobe G Fi'I Aenteriaf If Yes,type, .. ....- ..._. .. <br /> IP'ot plan, %h-owing sire of tot, location of system In relation to wells, bvildings, etc. must be placed on reverse skfe,l <br /> NEW INSTALLATION: (No septic tank or seepage pt peco fitted if public sewer is ovalioble within 200 feet) <br /> PACKAGE TREATMENT _(•) SEPTIC TANK j,1- - Sim'..-- . ..._. . .. - Liquid Depth ...... <br /> r <br /> ICapacity Type Mahn{ 1.... ' . . No. Comportments ... _.... . .. 00 <br /> t Noonce -to nearesa Well _.:Fovodotlon Prop. Lino ....... . ..,...... J <br /> LEACWNGLINE ( 1 No of Lars Lwvlh of sad+ Rae, Tarot tang* ....... <br /> J D' Box Tyne Fihor Mahrial...... .._.._... ...,Depth Filter MalvicA ...... . <br /> t r ' <br /> ' Otstanca to r•sorcst- Well ... .. ...._. FasMtdalitxt Praperr/ L°nor Z <br /> SEEPAGE PIT f 1 Depth .... Diameter . . . ___ Nang' . . -. Rock Filled Yes [': No [ <br /> 1 Wester Table Depth __ ... ........Rack Size <br /> Disronce to nearest,Well _.. ........ .....Foundation Prop- Line S <br /> REPAIR�ADDIiION iPrev. Sonitobon Permit 0 _ Doh 1 <br /> t Septic Tank (Sprdfir Requiromenfs! <br /> _ S^ <br /> Disposal Field 'Specify Requiranents) <br /> 7-- _ 2 i <br /> IDrow exis',r8 and rnqu.•rd add',tion on reverie side! <br /> IiherebY cMlfy that 1 have prepared this application and that rhe work will be done in accordance with San Jeagarin <br /> Corny Ordinances, Sroie Laws, and Rales and Regulations of the Son Jeaqula Local Muth District_ Marne owner or Hcetn- <br /> $t d agents signo1wri,certifies the following: <br /> "1 certify that in the Perfomreetee of the work for which this permit Is issued, 1 shall net empisy any Person in wch mommet <br /> as to b«eine subject b W e s eomponsarion lows of California" <br /> Signed Owner <br /> By f 7 .Sa., ]tele �r t f/Ld CH <br /> ( (If other than owned Y QQ <br /> _ ►OR OMARTMWf! Us ONLY <br /> APPLICATION ACCEPTER BY _.___ DATE -2<J <br /> BUILDING PERMIT ISSUED DATE <br /> ADDITIONAL COAkMENTS _.. ._ <br /> t Doft -a ... <br /> Fartpl ImpectaM bY: .r. ,'^�. . .... . <br /> SAN JOACJ1'Y LOCAE HEALTH DtSTRICT <br /> E. M. 9 1-'68 Rev. SM <br />