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FOR OFFICE USE:
<br /> APPLICATION ICOR SANITATION PERMIT
<br /> ..... ............................... T licate Permit No.��....
<br /> (Complete!n rip,
<br /> S 7
<br /> . . ,. ._ ; .. ' Date-Issued '
<br /> .. ....i . = , t t
<br /> -This Perniltiirxpiras it YearFrom Datelsstted. ,.
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<br /> j JL
<br /> Apptication is'hereby`'nade f6jhii ScritJodqush1'ocal Hedlfli Vitill6ffor;o"perrr►it to iohstru'ct and 1rista!!'the worts herain
<br /> described This application is.inade in..comptitlisce with,County Ordinance No.•549 and`.existing Rules and Regulations:
<br /> 2
<br /> JOB ADURESSAOCATION-./__7_ G/.. ,.?'L. f ._ cENsuS TRACT ... .
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<br /> Ciwner's Name., _ --�!`r��5'h � ' ._:............t..-Phone. -.
<br /> Address _ • .,
<br /> Contractor's Name __ I � r . License# VF4 Phone .......................... _
<br /> InStollQtion will serve-, d Residence[Apartment Housefl Commercial, Trailer Court 0 ,
<br /> Motel ❑Other . t.......................t - , l d i
<br /> a � i �_ - n
<br /> Number of (ii/ing units .:_'�_"_ `Number`of"bedrooms" ` Garbage Gfinder dot Size a 1 -=-°
<br /> s g # I s _ :..':_.. -_+ 4 o-
<br /> ........Private
<br /> Water Supply:.Public System and name -- 9 -� --.......................................... �
<br /> character of soil to a de th�ofl feeyt Sand L Silt ..3 -•CIaV Q= Peat. Sand loam e&'Clay Loom,❑
<br /> 5•. r . . .... ..a {tq Hargdpan[];.,»,Adobe , tali Mntertctl lf'yes;type .�
<br /> } £ i. F. S i. .l '�:-
<br /> (Piot`pian,"shovliing'size o#'lot;"Location of system In -relation I to wolls;'buildirigs, etc.$must be placed on reverse s1de.JQ
<br /> NEW IN5TALIATI6Ns (No septic tank or seeps etpit ,permitted ifpublic sewer,is avoilable'within 200 feet,J
<br /> PACKAGE,TREATMENT. ( ].r,•SEPTIC TANK jVf . •Y Size° �a'1.� '1.'i �� f.. _4_4_i Uquid pepfls
<br /> I i ' C aci / ............o _F__Type_ - Material. 4 zL .r�No.,,..C6m}�artm_ents_, __... .
<br /> 'SyF _ EF
<br /> i _
<br /> nce to yriearest: Well ----- .--�'� - Foundation �C?. .. . Prop.'Line ........
<br /> k .Disttl �- a
<br /> LEACHING LINE i'J+ No.,of Lines e... i Length of,each lige,. �-,-.�Q Iota! length Z: t'
<br /> Box ...° i Type Filter Material ' . � Depth Filter Material `/ r
<br /> �...
<br /> ` I - Distance to nearest: Well §... � _ Foundation --- .! $, ' Property Line�'..'` --
<br /> SEEPAGf f'IT Depth Diameter. __ ..zT_ ... t Numf3er F ... ...`..._ . Rock Filled Yes No ,�]
<br /> J F P } 1 ..'i t ..Roc f = :
<br /> �• � � Water' 1'abls D�pth � � �s •:Foundatiori-.'_.'. --'-•--•.�• p t - .
<br /> a ,
<br /> �y k Distance to nearest: Well .. i ` Pro 'line....:_:. ....
<br /> { { .... l
<br /> k, .... ..,- � s t
<br /> REPAIR/AQDITION(Prey Sanitation_PerMit# •............................................ to :
<br /> _s..�..,.� � . r.
<br /> .Septic,.7ank'(Specify;RequireinentsJ ...:. = 5
<br /> Disposat,•Fietd,„(Speeify Requiremenfs) ° ( - ( • ...............
<br /> l '
<br /> 1 - E twA T — .
<br /> l (Drdw ozistin and ie uired r ddlfth'dii ieverse siclo
<br /> I hereby certify:#hat 1.'hsrvapreparedTthis:ppplication and #hat.thetwork--w11i•be-doni,ln ac cordoneetwith San Joitq In
<br /> County Ordinances; State Laws, and Rules;`and-Regulations of the San Joaquin`:Coca! Health':District Home owner or' Ilcen-
<br /> :.,Y -�,: ...:r ,s-..x- p. - ...•w,. . .. .,,,.,,: - a;..,.,: ..,.v.,.- -z r .. .,,,,.. ..,;. ,y. ,;...-...+ o- ,.!•••+ �.+..<{row.,. . ..c�,..... -y.,
<br /> sod's ents si nature certifies the followin t-
<br /> 9 g' ( I a person In such manner
<br /> "I,certify that in'the performance of the-worts far which this;permit is Issued, !-shat! not employ esny'p y
<br /> as to beco"t a subject to Workman's Compensation laws of California
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<br /> Signed l i i '- �1 _ _ - rF
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<br /> � �,....�:�,.. Owner . ... .<� �
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<br /> Y itle
<br /> -- -------------
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<br /> (if-other than"own'erl. ;, F ,� i. � ,.I. �t•=. �' �M ,. ,' .,t,...>.-. s. �d
<br /> FOR.DEPARTMENT USE ONLY.. y€., z ... k:...
<br /> .r
<br /> a .......DATE---
<br /> APPLICATiON„'ACCEP.TED -,BY ..,.�. . -
<br /> IUILDING"PERMIT ISSUED ----------- -- - ...................................... - ---------_DATE -=u-.._.-................................_.
<br /> ADDITIONALCOMMENTS ---------------•------ -•---------- -- ----------- - ---•---- -------------------_------. ---------
<br /> ----------- .............................. -•-------- ................ --------- ---_----------
<br /> ------------------------- •--- -- - „- -•--••-___----. -- ___-_ _-. , - . _._-
<br /> � _.._....
<br /> e--------••-•-••-•--•...................................
<br /> Final Inspection by: ---- _ __ .. ....... Dat
<br /> EH 13 24 1-68 Rev. 514 S JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M
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