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<br />ioR ori=lcr: USE:
<br />APPLICATION FOR SANITATION PERMIT
<br />........ .............. .................... •...........
<br />_.
<br />.........................................
<br />Permit No.
<br />(Complete In Triplicates
<br />This Permit Expires 1 Year From Date Issued T Date Issued ... ' - .......
<br />Application is hereby made to the San Joaquin Local Health 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,
<br />108 ADDRESS LOCATION :.•/....•...CENSUS TRACT ...........................
<br />Owners Name i!l ,r ~, ..� .......... ' -• ..........i....>.€ --•._..Phone
<br />Address ... rCity":�.CCf:e`��„G%'`_.::'::::�:: a...... .
<br />�_,__. • t I_ ..... ... .. ........ ..;.. .
<br />Cf ntraa tors' Noifiep. : ,i i= _ j It m1 - : �` :::: } :_...' ... ::= license:i .oicldi . t��,:'w� "Pht iris s :�lr fi!`
<br />iristallationwillserve:;::�Reidence=ApartmenfHouse{�'Commercial'[j{'raiierCourt`{�°•;' '` •�
<br />.. .. $..._ :.... Motel; [}•Othen -- ......r.,:.::a:,•:,_ ..._ ::.t:u:.J.�_..,. ...,...` . «..... f t (»
<br />F I = ed :7' rbage G der..,,....;.....,..: "v
<br />Number of Jivin `units:...1, lVumbef.of;b rooms- Ga. rin J lot.Sze. ��' �\
<br />Water Su Ir! 5 stem arid names _ ;4 `-Prwate
<br />Character of sail to a depth of 3 feif Sand 0 ` Silt [3 bay � 11 Peat d Sandy Loam 'o i Cldy Loam tj i
<br />Is+Hardpah j]'. Adobe' Fi11 Material _ If�res,:type j E i '
<br />t . s ...
<br />{Pot Ian sh win size. of...lo , .locatian of..s stem in relation -iQ vrslls iau,ldings, .etc....must 5e. placed;.ost,,:reveise.side.�
<br />NEE-W-INST�►LLATION: • INo septic tank; or seep a; It_permitteii if Oublic.seweriis availdble.within 2§0 feet,),,
<br />PACKAGE ,TREATMENT ()� SE -PTI. TANK Siae � xy . a,. ._..Liquid Depth . ... a
<br />y� .i...., Y ..
<br />Copaci'ty :.<s `._. Type; Mdterial... ... .... No.] Corinpaftmertts ..,�.....A.......�
<br />L.......................a........s.. �,.. .,.,:.. ... . .....:... �._..'.i..... r..,.. -.......i.. ,.,
<br />t Distance to nearest: Well _._... Fobnddtion .. 't......__..` Prop. Line . .
<br />i I er._.... e ......
<br />x.,.. ...
<br />LEACHINsy LItV No. of lines ::. Length, of ac)i }lrie. _ ..r.: ,�i�ctaI Lengt}t ..,�1
<br />37"� , E
<br />D' Boil'"::. :.'"' "Type Filfei :Material' .: ptl•i Ilfiij --Ite'rfai _ /." a' ` .....y
<br />'j j, Distance to'nearest: Foandatiorr" :. Property Line' .—A,
<br />SEEPAGE PIT • C Depth. r t.; }...Diitmeter: J�Iumber, ti r_:t.,o=.3......r._: ?Rock...Fiiled•• i = 'i�10 (] _
<br />i ....;.... .,W.. ;ter...TGbl'p_ pth _ ` .--...Rock-$I, ...i...... ....... ...... . . i r .x
<br />: ,..............�
<br />e �...__. ...,,w.,..._......
<br />I Distance tofnearest:iWelt ;/ . .Foynda'tion"+a;r. Prb�j Line s
<br />..j. .... .}. > ..i. ..i.....4.... . ... ..� .....i ,il?;.x. •,:.-• .•
<br />ItSPAIR/ADDITION'jPrev, Sanitation' Permit [# _..... ............. ...s..... ~..... ~Ddte .;.....
<br />1Sepfic Tank (Specify Requ:remen)' ..;` -- ......:......:...... .. .. _. .. ........ .i...... ..
<br />iDisposat Field...(Spe4ify .Requirement} .- -• - ._ .� ...{.......... . ... .... ...?.... .. s .. _ .--_..
<br />,......:......e __t... ..�........
<br />............. .i:...i...................i. ...i.............- ? .. �..,. ......................
<br />+;
<br />;-......... .............r;.,t...................
<br />.. •....;.....................>
<br />t. ' -(Drciw of istiri ohd_re• uired ddition'on reverse side ` _
<br />I hereby cart:fy that t have prepared this dpplication and ,hist thewo k will ' t
<br />' ' a e { be done-iri' ccoidartite wish sSnn+ Joaquin
<br />Coa'nty flrdiiiah ei ' Stgte 1-d-ws;-'and RU as"dh ;Rag'vlations :. f tlio n "J.oaquin'X*cc Hiteiith f8iii iFt: Hoii+'e di iw i-wr••liten
<br />►
<br />sed ageMssigrtiature certifies.the..foi{owing:. •... ............:... . .,... ._....t,.,....�_.._.....,.,.......::...:..;.,.'�.....,.,.<_.:..._......,,.,,...,.,.......;.......�.......,.,
<br />"I acertify that.iii the perforrrianee of the work for winch this perrn: it N issired,il shall riol employ ajtr person ins strth mtinnet
<br />as`to beeisrite'siibjeet t Woi' 6n'iiCe'nipen%dtian law's of Califoreiut:Y•—=w= r'�
<br />Signed :. 4 ........'......'..,.Duinerr ...j,._.. 1...., � . ;.... _i ......:...... .
<br />By................. :..:::_�::.:........�.............. ... •........ .- ; =itis ; ..y.:: ..........................•r
<br />Of other than owner)
<br />.. ... ........�..., .i. M w, .t. ..... y........ �.............•.!_._... q,... .. _.l> ;. . ,5.... .nr _.. r ...0 .. ..1.....
<br />FOR DEPARTMENT USk ONLY:
<br />APPLICATION ACCEPTED i3,Y ... �'�,_ar..HI ED `J,,,,•.;, DATE +_-.f .�K
<br />BltikDiNG ERMITt:ISSUED " ' -.,. _ :_ ......... i
<br />i . , •:c: c::'::
<br />"DDJTJONAL COMMENTS ..... i
<br />....._._ .._.. ..... 1
<br />..... : i ! ....... . .s. ..
<br />7 0zu-". ....
<br />D...._
<br />Final Irispectiori by: .., rw '!•. nt�l.r.. . ASC1r _t=1.S �OC t•t•i ••2I
<br />/. .v, .. .. •4•.,'.•• •Tf-L:"t�`.....r..� ... �.�._� . ..'.t....r.�!!.': h!w r.... •
<br />3 SAN JOAQUIN l 'HEALTH!
<br />- r u 13 24,..•aa oet: SAA / 7/723 M
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