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<br /> FOR OFFICE USE: '
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<br /> {CempEets in Triplicate)
<br /> Permit No
<br /> APP1.iCATIC3N FOR SANITATION PER
<br /> P
<br /> Y, r.'.,.. ' Y Date Issd'.•=; 1:1f'_ .r
<br /> t . ............ .,
<br /> r This permit Expires 1 Year From,Date Issued
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<br /> it to f�
<br /> R r Applicat;on is hereby made to the
<br /> Son ac lin Loc l HeCoubYtOrdinance wor
<br /> Nom
<br /> 54S+ and exisring Rufesand tandhReguiationsfe
<br /> 4`- described.•This application
<br /> is P ` . .
<br /> NSUS'TRACT " J.
<br /> a JOB ADDRESS/LOCATION ................•.. ......Phone 7,
<br /> vent Owner's Name� *
<br /> :.:.
<br /> .....C1ty •---•.-- '--.....
<br /> .............4rr.ss '............... ?7
<br /> phone
<br /> .......License
<br /> i
<br /> *'rq Contractor s Name... 4
<br /> ' ortn+ent Mouse Commercial OTrailer Court j]
<br /> .Installation-will-sery Residence j]Ap
<br /> hµ7 $ ,(..
<br /> re: �>
<br /> " >f
<br /> Motel ❑other x;16.1 �/�........
<br /> 'Lot S12 7 7
<br /> r : TIR
<br /> Garbage Grinder :
<br /> ..� . '
<br /> .;Number of,liv�ngvmts.-...--....- Number of bedrooms , r
<br /> �* p ivate�?,�
<br /> .... .. ... ........... ....
<br /> xrn -r Water Supply! Public System and name ............ ........;.. K Clay Laam
<br /> x..; h. Peat Sandy Loam 0
<br /> Ctiaraderof soil to a depth of 3 feet: Sand U Slit❑ Clay I]:S {; -� ,-�
<br /> t Fill Material .... if yes.typeTr `
<br /> t•, ::b:. Yf T" 4. Adobe •• -,.� " „-,jr•.•
<br /> � � �;•.t r .-, : •; Hardpan❑
<br /> > , ' ' ;on.,reverse-'side 1
<br /> Piot{ Ian' showing size'af lot; location of"system in relation to wells,buildings,f etc. must be
<br /> ,p°acedt �.. '£ F`
<br /> s' .., z
<br /> P, a[..,..�?, ., rplzy it permitted if public.sewer is ava�table with n 2��ft�e�t
<br /> Cyt
<br /> 'A NEW-- DN: {No septic tank cr seepage P F /y t -�� �- � i vidwRa th ?y1
<br /> " 5EPTICTANK .r _N6.
<br /> 'PACKAGE:7REATMENT [ } "MateriaiG paitme�nf
<br /> v y ,
<br /> i
<br /> Capocity �O. TYPe Pr i
<br /> :....:..:.Founuat�an , L no
<br /> Distance to nearest:.Well
<br /> ' Total lehgth
<br /> Length of eich.Iine..._'?- .' .v7
<br /> -- n .............
<br /> No. of Lines -L g a ry '
<br /> y1EACHWG'LINE; peg h Filterj'Material
<br /> ` Type Filter MQteriQl DG.I P,�� : } s' tryi L"tee ,
<br /> ProperyrLln r
<br /> /lP....' Foundation'• 4 . fin.. , u r Rtt.;
<br /> Distance to nearest Wel! �� s '.Rr mss/ /k?Filled rYes"V lea ' I
<br /> Diameter , - ",rYf.�'�e
<br /> ..
<br /> y -� Number, art /,� ' ; rc
<br /> , rtSEEpAGF'PIT" b } depth
<br /> .;Water..b f.. - Foundation-.
<br /> 1� PropLine � " a,
<br /> Depth `:--.. GAG.-�.� rTl4r�, 1
<br /> moDistance to nearest: Well ..-... ....................
<br /> f Date
<br /> ' ..rav�5arrtation permit�` -•-
<br /> '�REPAlR/ADDITION i
<br /> eel Requirements} ,w r� t"
<br /> ....
<br /> 'Septic Tank,(Sp ,fY ,
<br /> �- .
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<br /> _k�/`Xi,Pr{ Df��;FssDfisposd•itl `--' ' fy Rq
<br /> ire-
<br /> menutsjField (Spen
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<br /> Tx ...._.. r'
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<br /> r e•-. . e _
<br /> ddit on'reverseside)i ;�:! � �,n• ,���•
<br /> y ''`[Dra'N existing and required a ion. t r+
<br /> i' ' lTcation and that the; work rwillr be done in,occerdanaSan aoaq
<br /> ,!;hareby;certlfy that ! have prepared this'app q t t1 sr- ;"", -
<br /> , � r tounfy Ordinancos,f5tate.Lows, and Ruiis•and Regulations of the San ica,�uin Local( District Heme.o
<br /> �`" �{
<br /> �F , st., .•, i{ %lo an ergen-1n such manner.
<br /> si shn11, not'emp Y Y P
<br /> r,aed.agents s1gr stare certifies the following, grmit is issued, '?t tta•
<br /> ,aa :9 :f tMl' r1. '!•.t it �,tKr..
<br /> 'ark"1-certify that Fn the perf trmance of the woric for which this p ,: r J {
<br /> t{� "
<br /> Corr ensation laws of Californian r . ,.` n ,
<br /> }., as to become :abject to Workman's i P =
<br /> l o
<br /> 4+. . Owner
<br /> t •':�s' Signed Jule . .
<br /> 24
<br /> :�/�•.......... y. ,'.�-^r-.',a•'"t" �,�M. :r4 .fir- f.,
<br /> 4
<br /> By -kkx•, ,lcUther than'oW
<br /> FOR DEPARTMENT USE ONLY;MXIM
<br /> std ti� k;Ac ,�
<br /> .- ........................... ......
<br /> t:7 i _ 'Y
<br /> �;t 'APPLICATION gACCEPTfD'BY
<br /> t lD
<br /> ATE-• ....: '.�
<br /> ,,.....
<br /> �j'�r'; BUILDINGrPERM1T ISSUED.................. ,
<br /> _ADDITIONAL;COMMENTS:.... 5 -- - '
<br /> 'r ................:.:....... _ ....r............. • :? ........................1 .. �.: .
<br /> � .....
<br /> :.-. ;
<br /> ' ........ ..................... Date
<br /> Final.lnspection'b. : •.,.. DISTRICT t a, rtZ
<br /> ;+ �A
<br /> 4 LI gieN ,, SANQUIN LOCAL F4EALTF! . , 6 ttpvS ;s s•`r 'x tes 'r",+
<br /> +��- y- •fir ,r .. -ail �� .. Y J , - -_ '
<br /> 58 Rev�5M kit
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