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FOR OFFICE USE:
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<br /> APPLICATION FOR SANITATION PERMIT
<br /> Perml#No
<br /> Kon+pkte In�riplicatel. _
<br /> :,..,.:..:I..:.. • -This Perntltlxplres 1 Yearfrom Date Issued i .. i flats 1s ued
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<br /> 3 F t [ ! 4 €
<br /> App€kation is,hereby made f6-the'San'Joaquin-,:local HealtF 'District'fo�x a permit to construct and T install tie 'work herein
<br /> ,described. This applicatiart is Made in,corriplia°hce with.County Ordinance No. 549,'andexisting Rules and,Regulations:i
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<br /> JOB AD©RfSS/ OCAiON'IZ_cl._5_ ..--- .._ ?-rc i
<br /> CENSUS TRACT
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<br /> Owner's_Name, +� {.. Phone lot _
<br /> Address _ 11 ! _ :........
<br /> r,. zaQ i �. t. !CI s' i
<br /> Contractors Name__ ---- ----------_ ---_----------..:1.{'rPhone ...-- ------- • --�-- d
<br /> Installation will serve:. Residence jb�r4art6ent House Commercial_oTra€lerCourt E]
<br /> 3.
<br /> I Motel ❑Other ----......................
<br /> a'y i
<br /> Number of living units:-:-.�:..__ Number of,bedeerooms`_a---_....__Garbage Grinder Lot 91 ....................F�
<br /> � I3y
<br /> 1Nater 5upply:a Public System 'and name:`�:4' :._:. , _,_ _ 4 i ° - ......" ..
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<br /> f a Y .............., __. �:_ ..,. .. .... Private 9
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<br /> Character of soil to a depth of 3 feet. Sand Silf Cla Peaf $and -Loam — Cla Loam
<br /> a P 'f ❑s D Y L�' D a Y Y [
<br /> .. ,_ ... Hardpan !]. Adobe fl .Fill Materlpf .. . if,yes;type............... .........
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<br /> (Piot plan; 'showing size of lot, location of aystemr In rely#€on€to wells, i;uildings, etc must be placed n" reverse;side.)
<br /> NEW iNSTAitLAT10N: , (No septic tank or seepage,pit-permltted if ublic sewer is available within 200 feet,)
<br /> PAG KAGE�TIZEATMI"NTf [ ]i -�SEPTIC'TANK y :; Size ��� .�; ��!` . .. Liquid,
<br /> each
<br /> i
<br /> '._Capacity,L _d. .Type No. Compartments .__. .......... 1
<br /> I ` Distance l toi nekarest: Well S_ i _ ?_ ir__ r ' a :Fovnddtion' .���..�.. Prop.;Line.
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<br /> Ni_ACHING LINE I Total lengthot ik s L ...
<br /> _ Type FiIter Material Depth Fil#er Material-- / ........................•`
<br /> • DkstanEe to nearest: Well T."'5. __ Foundation . f`.f..._. Property line :............ -
<br /> SEEPAGE PIT.,i ; ,.p .,h ., a. i.....�..... ..... ..... l
<br /> [ 1 : pt. Diameter Number Rock Filled -Yes 0 No 0
<br /> --- —IT # ""
<br /> f Dissance to neatest.'Well � t ...Foundbtion Pro Llne #
<br /> j Water Viable De th Rock Sixe
<br /> ' �. p i l t $ i p i
<br /> ltfPAlR/ADDlT10N�{Prev. SpF
<br /> anitction Permit ` _. .-- - _- -_ Date . f ... ---: _-I ` • 8
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<br /> ..septic Tanl< (SpetifyRequicements) :--- --. .. _. _ .._-_•-------_- .,.._ ..
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<br /> Disposal,Field ISpetify 'Requirements., 1 ' _ .................... I .
<br /> ------ •---------- -------=---••---- -- - -- - - - . ....__.__ _._ .
<br /> " ..' " ""'"l'•� {Draw existisig'and-require$additioii'on reverse tide)"` : '� "" - : t ._ • .f
<br /> I hereby,certify-that )-,have prepared,this,application and .that-the,work will be,done.in.I accordance with�San .loagvin
<br /> County Ordinances, State laws, and Itules'and Regulations of the San iloaquln,Local Health.District:Hone owner or linen.
<br /> sed agents signature certifies the following:
<br /> "I.cerfify that in the.perfor�nance of the work for-whlch,thlx:-perrnit is Issued, I sholl not employ any person in such eiianner
<br /> 9 to become sub ect to Workman's Cam esat'r�on lawsOf Calr rnOwner ' : I
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<br /> .Sl ned _.. 4 tis
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<br /> _......._y = Title
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<br /> {If--other than:-owraerl..i,�,. ...�_.�........ „-.+«<er.w:<• ., �.,.�...g,
<br /> -FORDIEPARTMONLY_ F i• i x ., z
<br /> ENT..USE.. '
<br /> PPLICATIOWACCEPTED_gY_J...6:--- ET. ... '
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<br /> BUiLDING`PEWIT ISSUED . DATE
<br /> ... .: ............... "---- ------------------------ ,
<br /> ADDITIONAL COMMENTS ...... ...................... ...... •.................. i
<br /> ,..----•-----------•----------- .................................----------------------------------------•--- _..__...._.__..-----..._..-----------.----------...... ..""-._..------.---._..._..._...
<br /> ------------------- ---------------- .......... .......
<br /> ....._ To
<br /> o-/JOACQUIN
<br /> ....,-------------•----•----------.-.-.._•--:.-----._.--------- --.._ .
<br /> Finol Inspection by. ....................... __ - .
<br /> _...---- ......................:............• ----•-....._._•.._....---••-Date ,S�'-..�_.� -. . . ...--------------
<br /> lH 13 4 1-68 Rev. 5m SA LOCAL HEALTH DISTRICT 8/74 3M
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