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FOR OFFICE: <br /> ,P <br /> - LICATION VOR SANITATION PERMIT <br />:................. .0`1� .........._.._.' ...._ (Complete in Triplicate). _......- . . Permit NA. .7 �.�.�.. <br /> �.. <br />:......... .......... ...:...'........ .............- Date issued . / ............ <br /> This Permit Sx Cres 1.Year from Date Issued <br /> ?7 <br /> Me <br /> civiv ellis� <br /> Application is hereby made to the San Joaquin Local Health:District for permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinan Na. 549 and existing Rules and Regulations: <br /> r <br />"�. JOB ADDRESS/LOCATI / v?[a.S� Jf� L..................CENSUS TRACT _.• ..-- <br /> .. d .......... ......... ...::....................................:..:. ..:... n <br /> Owner's Name _... Phone .. •........... ........... 7 <br /> Address ................:...Cityrv`.r_...._............_....._.......__.... -- <br /> ------ <br /> ' --.. Ph ... ... •------------- <br />; : Contractor's Nome __--.Q'�2e�-r•-•------- n ilex Court <br /> License,t�` one <br /> Installation will serve: Residence}Apartment House 1--1 Commercial[3Tra 0 <br /> fMotel []Other .-------•---.......:...............: ..... �, . <br /> Number of livingunits:----1 Number of Bedrooms Garbage Grinder ---- Lot Size � <br /> �'`' ' _----- <br /> Water Supply: Public System and name ......... ................ �� L.�.._. j_._ P..�P�_ ' �1.. e i/� .Private <br /> depth 3 feet: Sand Silt❑ --Clay ❑ Peat❑ Sandy Loam ❑ <br /> Character of soil to a deptClay loam❑ .: <br /> ' Hardpan❑ Adore 0 Fill Material ............ If yes,type............... .......... <br /> (Plot pian, sowing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.} <br /> NEW INSTACIATION: (No septic-tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE'TREATMENT [ ] xSEPTIC TANK I ] Size.. .:.:�.:�.:..::.................:.... liquid Depth .-----...--- -- <br /> h CUD �+ / - No. CompartMents �=- -...,....._? { <br /> Capacity ,! ••------ Type t �Niater[al_4 �. i <br /> ,.Foundation ---...--- Prop. Line . <br /> Distance to nearest:Well,• -/0 -........... _ -- <br /> <: - , , <br /> ' l SEL ACHING-,LINE ] No. of•lines F -- =' length of each line--. 3 a1 Length . <br /> - -�, -• 'Tot Le r,�.S � Ul <br /> lleP— 91- _ 'D' Box _.�•---'. Type Filter Material ..�..--Depth Filter..Material .-....1-�t.............� •--• <br /> Distance to nearest: Well 00..-- . Foundation...._ r............ Property Line .... .:.......�.....,. <br /> rf -I ... ...................... w On -•................. ...........,......._. D <br /> REPAIR/ADDITION lPrev. Sanitation Permit Y# <br /> ............ ......... .........:... Dat® ........---=----...._.._.. - --••) <br /> Septic Tank(Specify Requirements)-•-_ :... --- .- . ........................- -•---.... - .. ....._s. ........... <br /> ,.�- l d e <br /> Disposal Field (Specify Requirements} <br /> " .... <br /> F ______________________---------------------------------------4 _g ........... ..._....._.......___ -------- <br /> ------------- <br /> -.--. _ -_._... _._._........ <br /> hereby cern that I have prepared this p plicati - # <br /> 1 h y fy p P i nd required addition on hei verse side) f <br />� - • �•-------�•'- ---- - (Draw existing cn .and-=that 'the work witl�be ono iin'�accnrdanca with San Joaquin <br /> I <br /> County�Ordinances, State Laws, and Rules and� te4ulotlonsgtf fheJan Joaquin Lai a!`'Heahh dlstrict.'Hame owner Or liceet- <br /> sed agents signature certifies the following: <br /> '"' erson In such manner <br /> "I certify that in the performance of.#ie,*ork for`:kWch this permttxis Issued, I shall nol�en+piay any p <br /> as to beton+ subject to W rk 'a Compensation laws ot'.Cal irnia." <br /> --- ''`------- Owner <br /> 1 Signed ---.U�- .. . ..... <br /> By ------------------- <br /> Title °`--------- -------- <br /> lif other4han owner) <br /> P117DEPARMENT USE ONLY <br /> APPLICATION ACCEPTED By _.__.---------- ------- _• �:._ ... = � "-=-*------ DATE .� ,.��..T�......_......__.__ <br /> BUILDING PERMIT ISSUED ------- --- ------ <br /> DAT .... <br /> ADDITIONAL COMMENTS ..- �,�cef {1'Ir¢JJ '�lo=• �+� ,.... . ................ <br /> ... E - _ _._ ... -----------M :............. <br /> p Y i... ...... t. ' .. . Date _ , <br /> -----------•-•--- '_..._. _ . .. <br /> Final Inspection b ----_ --- •... .....:... ...:., , <br /> EH 13 24 1.-613 Rev. 5M SAN. JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />