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FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT /I
<br /> ...................... {Com lets I 1 ) Permit No. 77'.=/07 S�
<br /> �` P .......
<br /> ••-•......... .... This Permit Expires 1 Year From baro Issued Date Issued /l'v?�,`7S�
<br /> Application is hereby made to the San Joaquin ealth istC f
<br /> al Hor a per it to construct 'and install the work herein
<br /> described. This application is made in compliance with Countybrdin e-No --544,and existing Rules and Regulations:
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<br /> JOB ADDRESS/LbCAT(O� ._.�If.,G .. ...... • • . . .4 �7p-t7y.
<br /> _ p '` _ f.......... .....CENSUS TRACT ..P. :_.
<br /> Owner's Name .... O
<br /> _........ ,....
<br /> ..
<br /> Address //Sra.... .. t?+� /_�4'''. City . .............. ... �
<br /> ......,..,. ---....... Phone Z�
<br /> Contractor's Nome .. .......... .. _.. ,.14s'~?� J.......:_.__,License #!w.7-. -�/C?.�..-- phone 1 ���6 ._ -f-
<br /> .......
<br /> In tllon will serve- Residence Apartment Nouse[( Commercial flTrailer Court j]
<br /> 0 Motel []Other
<br /> Number of living units:..... __._ . Number of bedrooms ..,,'...Garbage Grinder . .......... Lot Size ....A0......._.
<br /> l ....�
<br /> Water Supply:,,Public System and''ngme .............. .. Private
<br /> ......•................•-•........................... ...-------..,......._..........:.:--•--••-----.
<br /> Choracter•of soil to 8epth of,3�feet: Sand[] Silt❑ Clay El Peat E] Sandy Loam Clay loom.❑
<br /> Hardpan r�' Adobe Fill Material ...... •-... If yes,tyre_..
<br /> (Plot plan, showing size of"I locatiori�f- te,t i'iiarelation to w;e(Is, ^A� � ^'`r�
<br /> 4. ' y . m ,y, buildings, etc. must be placed on revetsiceside,j
<br /> NEW INSTALLATION: (No septic t�nk�or seepage pat•petmitted if p� (ic seZ is available within 200 feet,) Y
<br /> PACKAGE TREATMENT q• y
<br /> 17 SEPTIC TANK Size` �( :" "` �.
<br /> -A r - • '"�� ._.._...... Liquid ....:w'`..�•f..c _.._.
<br /> Cp Cit .
<br /> ._.
<br /> Pa Y f .•Type Matetidl.. 'r Nv. y'6otnpartments ._..U
<br /> Distance to nearest. Well
<br /> -• _ ... ._.._Foundation ....14,. ?,..., Prop. Line ....vr?... `..,.,
<br /> Length of each (ine.....:.� .
<br /> A �
<br /> LEACHING UNE No. of Lines .......•. Total length ............
<br /> D' Box .._...��Type Filter Material _f'-�✓`�"�._..Qepth Filter Material .•........,� .�'. d
<br /> .....•...............
<br /> • - r r
<br /> Distance to nearest: Well _57-0.1...�......... Foundation . ..f-C?,-`F'... Property Line .. .. `,
<br /> SEEPAGi PIT ° Depth ..... Diameter .;ST.'S...... Number ....... - Rock Filled Yes No C]
<br /> �[
<br /> Water Table Depth .........J. lt{y.k�a �,�:t�j t1t,-pock Size ...I./ ��x,.�. .�
<br /> Distance to nearest: Well .......fi(�Q._.7�"_. ___,._..,.Foundation ....fill...(f*._.. Prop. Line ..��' �;`.._..•
<br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......................................... _. Date ----•----_-_-------_ .-
<br /> Septic Tank (Specify Retquirements) ....... ........................................................... :........_.._._...... .._. . _.
<br /> Disposal Field. (Specify Requirements) ...........-_.........................•...... ._
<br /> -, .. ..... .... ..........-_................. ........... �.................. ........................... - ...z.. . ,��,.-<Nff (''
<br /> -• .......
<br /> ............
<br /> ......................................................................
<br /> .......'.:_:...:•t'-::z:�_n.5._... .—=r.,--r.-r:- -�
<br /> (Dra'w existing and required addition on reverse side)
<br /> I hereby rtify that I Mavis prepared this appeliceiiion and that the work will ho deno Ire
<br /> atcorcfamers With Sam •It►aqul+t
<br /> Goru'dy%4rhinoncot, State Lows, and Ruler, and Reguicationd of the Scan Jenrquieo l.t wl 9lealita njiAtritt. Martie owner or Ilton,setl aggnis signaturo tertifieu the following:
<br /> "I ceriifyjtliat in the performance of the work for which this permit is issuer!, t 1114111 110 employ 04ty Pearson in sloth martnef
<br /> aR•ta WAQi1e subject to Workman's Compeeitatio►e low* of California."
<br /> I '
<br /> Signed .:.. . ... ......... I' Owner
<br /> .. . ........ ................
<br /> Title . ... ....'........... ....... ....... ....... ........... F
<br /> f I f othe t an owner) ,
<br /> _ FOR DEPARTMENT USE ONLY
<br /> AP�PEICATI N ACCEPTED BY... .......C'y •_... . ... . ........ DATE ._....1..` ',.' ......:........
<br /> BUILDING PERMIT ISSUED - -........
<br /> ADDITION L COMMENTS ..//.. .fib ..�50_. AT
<br /> .... .. ... ... : ':. : .•..... ... .......
<br /> .... ...........
<br /> . • ....... , ... . ...................•-....._.............---•--............._.........................................
<br /> . ..".................................. ...............1
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<br /> Firial lnspe tion by: ..............Ceo................_.....---...----.-•----...._...._........._..----"-.........- :... : ..
<br /> Date .............
<br /> SAN JOAOUIN LOCAL ._HFALTI-I DISTRICT c%A.
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