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"FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT
<br />............................... ;Complete in Triplicate)perm)t Alo..7 - -- TI//....
<br />......,.....,.....•.................. .. Date Issued
<br />This Pemtit Expires 1 Year From Date issued
<br />Application is hereby made to the San Jo oquin 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 Regulatianar
<br />JOS ADDRESS/COCAT r. . .. `2-` ../. r�+ ±�rr..� . c....... ...........CENSU5«TRACT ..,...». ,,,..,»....,..,.
<br />Owner's Name �=,�t l?!,rl.%�+1!. ,�r! !`' -• ""..................... Phone ......,.,....,..., •...,,.,..ww..,.
<br />Address..... .S._.��.i. ....� .., .... . city ..... ......................a..,.«r.,.......«.........,,....,,
<br />Contractor's Ne.b .. ,,,.».....,.
<br />Residence muse Commercial raller Court 0
<br />Installation will serve: Aa 'D �
<br />Motel (❑ Other ...................
<br />Number of living unitst.......... Number of bedrooms ..,w.Garbage Grinder .:.•.>... Last Size ......�'�?�~ .''� "�'��'!ii°"...
<br />Water Supply. public System and name ..... ......._......... ................. ,..,,ti ........ ..,..._....... ... ............ ._.::.Private eool*"
<br />Character of sail to a depth of 3 feet: ; Sand C] . Silt Q • Gay (:'Peat 0 Sandy Loom Clay Loam �
<br />Hardpan 4000" Adobe Ej Fill f> 3ftrlal yes, type
<br />(Plot plan, showing size of lot, lac(tiozn of, system in relation' to v as, .puddings, etc. must be placed reverse side.)
<br />NEW INSTALLATION., (No septic tank or seepoge pit permitted if aubtlic sewer Is available within 200 feet,)
<br />PACT GE TREATMENT (] SEPTIC TANK (n" Size. ?r ..,. X. -fir __. .. .... Liquid Depth ....j ................
<br />1! � .
<br />Capacity � T ll+tatetittl_..��1'``"�"'"'� No. Compartments
<br />t i ...• ��"..•........ 1'
<br />Distant& trete y�i 1 a,,.r.. � b... J� :.,.,•.....,Foundation ... �.f� . �.� `... Profs. kin*
<br />J 'HIND LINE ( No.. of Lines , .., ......... Length of ea t Ilne.........4-9-p.r.... Total Length 00
<br />'D• & ... •. Type Filtee tii4aterial Filter mesal .....1+ '>........... ..... ... id
<br />Distance to'nearest, Well , .>. .. � t�Iatlen .,.,��!.�� Property Lines ...
<br />SEEPAGE PIT ieJ Depth ...., �:l'X t31ar+�eter . �.. � Numkur ..__....,�.. Pack Filled Yes (�"""�t+Io
<br />Water Table Depth ............ �.�p. :.,.....SJte�cic Size ...._�'.....
<br />Distance to neo att Well ..Ilr"! ? _Foundation _./42 wr Pr+op. Line
<br />REPAIR/ADDIYION (Prov. Sanitation Permit # ... ...w, ........ ...__•._ .•.. r..r r... _. • Date...............«........,...,.,.�
<br />Septic Tank (Specify Requirernents) ...•....«..w,......>. ........ ................. ....» ........... __....,».».,...•. ...............�
<br />Disposal Field (Specify Requirements) .•..•......»w ...... ........•.,... ..... , .. _.......•.._.•.•........,..,w. >w...,.....,..•. ••,. .
<br />w•.•.«..ra........,w...`.....as.•.�.....w•..r.... s.«�.•. •,•...,Y •.•..ww._. w.-...a•ww•«._`....•+._.,,,w..-=....r+.._.r..,...Ys.fw..............•..u...w...s...•........... ....... «+sw.v.•.�wr.•
<br />...... ......
<br />._... ..... ....r.. .... w
<br />(Draw existing and required addition an reverse side)
<br />I hereby certify that I have preparod' this application and that the work wfiq br doter 14 artordasire with 'San , o"Wn
<br />County Ordinances, State Lays, and Rules and Regulations; of *0 San Jearluin Local IIS 0"iesiw Home owner or licsw►-
<br />sad agents signature certifiers the folloowingt
<br />"i certify that in the performance of the work' ter which this permit its issued, I SWI not employ a»y. p*rson M soon roamer
<br />as to become subject to Workman's Comp*nsatlon laws of California.
<br />Signed...................................... , .....,........ t3w+ner �y,
<br />By ................ s .. . Title . .!.... ur...r....................w{.,w.�.,...........
<br />(If other than owner)
<br />FOR DEPARTMENT USE ONLY
<br />APPLICATION ACCEPTED 8Y ... ......__..__ •.ww.,w.wrr.rw..r......._........... ....... . ., DATl,.,:.Wr--------
<br />BUILDINGPERMIT ISSUED w...,.. ....... ..................... .............. .....»........ DA k.. .. ....•.........•.............
<br />'ITIONAL COMMENTS . .. �. ..................... ........ .................... ,_.................I ..... ...... .....>......._.
<br />...................................».»............ ......... ........... ».........,...•.._._. .. _....................
<br />........ _............. c.<.> .............. ....... , ... .... ........•....... ...
<br />.........•........_..... ..... �,. ". ��, . w.�� ... � . ..........Final Final Inspection by.........._"...............................................;_..» ..., .>....w..,-., ,.....,...,-
<br />SAN JOAQUINLOCAL' HEALTH Ct.....wws �. W
<br />r- u 13 24 t.�AA P. 1;AA 7/72 3,M
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