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,.. _-_. :,_.,OFFICE USE: APPLICATION FOR SANITATION PERMIT
<br /> FOR O
<br /> -.' ��':'.'.....;�•...................... Permit No.
<br /> (Complete in Triplicate)
<br /> ....................................._......,
<br /> , Issued _...`.�:.
<br /> „-. This Permit Expires ] Year from Date Issued
<br /> Application,is hereby made to the San Joaquin Loco l'kealth District for a permit to construct and install the work herein
<br /> -described. This application is made in compliance With County Ordinance No. 549 and existing Rules and Regulations-
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<br /> JOB ADDRESS/LOCATION / Gam_ ..._°... ., /J-. :?i�!�� _._.._., , .__...__CENSUS TitACT g
<br /> ` .. .1 Phone .
<br /> Owners Name ll ., �r+tlar -- �/�+
<br /> f' A ' S .[.:lml
<br /> Addie s...i F .. �1 ,,,__ City `
<br /> Contractor's Name :': :' : 1 C --- -- Ueense` 6 4 Pltdfi � c'`'1�14
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<br /> Woolf otion will seine:' -Re§idence•k-Apartment House C� rrrmercial Q`frailer CourtE ;
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<br /> i j ..-. ..... Mote(:.
<br /> Nl�mbe,r of.,livin.g urilt : J..,.,: Number of,bed:rooms ... •:..Gc�rba e Grinc#er '__._._j,. ..Lot 5+xe Vis.•--
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<br /> Water,Supply Public System and name'
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<br /> Character of soil to a depth'of 3 feet: Sand Silt❑ Clay Peat 0 Sandy Loam ❑ Clay Loam ❑ M
<br /> Hardpah ❑ yes.ty
<br /> Adobe Pe
<br /> [j fill Matenal
<br /> (Plot plan' ,siie of...lof, .Iocatioii._of:.,system in..relations to vs+ells, bu.ildings,..etc tmusfi..be' plated on.,:.'�reverse..,sidel
<br /> NEW INSTALLATION (No septic tank or seeppge':pit permitted if pii6lic sewer.is available withtn 260 feet,.i
<br /> ` Liquid [depth Y
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<br /> PACKAGE:TREATMENT` [ ] SEPTIC TANK(. j
<br /> Capacity "!,..,. Typ®I,_.JMGteritsl '----- -- Na Compartments
<br /> Distance to nearest. Well ____ .. ""'
<br /> ..... __.Foundation'/,6...._.`::_-_.. Prop Line i. .•.
<br /> LEACHING.LINE [ j No. of;Lines _ _ Length of each iine.. .-j_ LengtF� .. .
<br /> 4. Sir th,,.°Filter "Materiil" : /:{
<br /> 7 D` Box'-:--::_: Type`Filter MtiteFial '
<br /> Distance-to nearest,Well
<br /> Fownddtiari -Property,:,Li .......� .
<br /> SEPAGI: PIT - =(..I Depth F __ ,.•:• `ltxk F�Iled..,Yest.[jat....No {
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<br /> Distance to neaiest: Well . Foundation z r Prop Line�� #
<br /> RIPAIRJADDITiON(Prev Sanitation Permit dt
<br /> Date _ .
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<br /> ;Septic Tank jSpecify Requirement's} .. ' ... --• •. .. . ... '
<br /> i6isposal Field {Specify Requirements) }_ 'x - •- :y „
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<br /> Draw existir9g aid required addition on reverse side) 3
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<br /> I hereby certify that 1 have prepared this rfppli anon and fiat ;the work will 4e doneiin accoidante with;San Joagain
<br /> Couiily Ordinances;`State Laws,•arid"•Ru.les'and';Itegulations of th6'San Joaquin`Loca1"Health'Disfr ct:'Htfiiri'�'oi rit r r e
<br /> e lic n-
<br /> se4 agents signature jceoifiei the,folfowing:. .-. , _.........._.
<br /> "I?certify that in the performance of; the'work for which this permit is issyed„1 shag not employ atiy pafsonAin;such manner:
<br /> as-to become subject"t kmd'n' ompensation laws of Californicl�'�
<br /> Signed Owner
<br /> �F
<br /> 13y ...................... _- .E i ._ _ .. .. T►file- ;. .. V _ _ .. __
<br /> (If other than owner) QR
<br /> rI, ' ' .; ..
<br /> y..., EI_ E' RTNIEN7 IiSE ONLY is
<br /> APPLICATION ACCEPTED 8Y __. Dari: ._% •s + i
<br /> BUILDING PERMIT-4SSUED . :. - . �.::::�::.......... DATE °s :�....._i._.. a::._.
<br /> ADDITIONAL COMMENTS .... r` t !. .. v------ ___-' -•
<br /> 4„,...�. :.� r... r .:_.". :Fg .
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<br /> ...........:...
<br /> Final inspection by ' _ .
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<br /> `�r-�• ,.�
<br /> N JOAQQIN LOCAL �-IEALTH' DISTRICT , 1 �.,.,
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<br /> 7/72 3 M
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