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FOR OFFICE USE: 'eJ?A.PPLICATION FOR SANITATION PERMIT -3 5-� <br /> Permit No. le--------------- <br /> ----------------------------------------------------- (Complete in Triplicate) <br /> 7Q� _' te issued _157-.�_- -"() <br /> 'i"� ba <br /> _0 This-Permit Expires I Year Frc?T,Datt-Is$ I <br /> ---------------------- <br /> A_� � I . 1 __j_ , � . <br /> I made <br /> i-� r 1-71 d i -fill ih'eZWork herein <br /> I 'Pj��S_an joacluin"�Locdl'H��ith%D-istri& fdr:lb-\pern:�if `tbVconstruct\6n iris <br /> tall <br /> ad'&to't e -��ncl Regulations: <br /> Application R+16reby m <br /> described. This application is made in compliance with County,-Ofo i nance-,No-�549,and existingjRules <br /> S`TIK ----- <br /> 4,'�----CENSUS TRACT <br /> JOB ADDRESS/LOCATION <br /> 3- --- --------------- ------------------------------------ <br /> DR-LIP - I ­-------Phone <br /> Owner's Name ------�jo,_)V_r-------- __P_R_ <br /> Address ---------- ......../W19R1-P0-5-'9­----------------------- City ---- ------ -----------------I------------------------- - <br /> Contractor's Name --------owwf�K 4-------- -------- -----•-- - --- - -- -- <br /> w----------License# --------- -------------- Phone -------------------------------- <br /> ial ❑Trallerwfil;Mt ;[}-"- <br /> Motel <br /> Installation will serve: Residence M Apartment House M Commerc .[] <br /> MotelE] Other -------------------------------------------- <br /> rooms ___/------Garbage Grinder IVO---- Lot Size' __,4jMjF_. --&:F—---------- <br /> R <br /> Nurnberlof' l ving units:___]-_____ Number of bed <br /> 1, Private <br /> y-A <br /> Water Supply System and name ------------------------------------------------------------------------------- <br /> - <br /> Character of soil t depth of 3 feet: Sand'Q ) SiltCl Clay El peat F] Sandy Loom -E] ClayLoam <br /> "',-Hardpan Jt Adobe E] Fill Material ------------ If yes,type ---------------------------- <br /> I . I ) <br /> on of system in relation to, wells, buildings, etc. must be placed on reverse side.) (1� <br /> (Plot plan, showing size of lot, locati 'I `1,1_) <br /> available within 200 feet,) <br /> NEW INSTALLATION: (No septic tank or seepage 'pit permitted if public sewer is <br /> J[Size-------------------------------------------- *Liquid Depth ------------------ <br /> PACKAGE TREATMENT f I SE PT I C TANK'[,II <�_' <br /> 1 ----- - Material____---_--- No. Compartments -----z------- -------- <br /> Typ <br /> rAa�a city ------------ ------------- <br /> �I ---Foundation -A------------------- Prop. Line -------------------- <br /> Distance to nearest: Well --------------------------------- / . I <br /> . 1. .. ._ .. �;Ix--—_. I _\ /_..,/ - ------- Total Lqn6ih ----------_---------------- <br /> LEACHING LINE No. of Lines ---------------------- - Length of each line------ ---- -- <br /> 1 .1 Filte Material --------------------A--------------------- <br /> *D' B6xAJ <br /> - ---------.- Type Filter Material --------------------De Foundation'"----------- -------- Property Line ------------------------ <br /> Distance to nearest: Well -- --------------------- <br /> --- Number Rock Filled Yes 0 No <br /> t <br /> e <br /> SEEPAGE PIT <br /> De ------------- Diame*r ------------- --------- ---------- <br /> III ' ------------------"--- -•---- <br /> Table Depth ----------- ---------------------------r---------bock Size <br /> -------------------- Prop. Line -------------- <br /> ;Distance to nearest., Well ---------------- ------- <br /> -'Y' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ='------ --- ---------------------- <br /> --------------- <br /> ------------- ---------------------------------- ------------ <br /> Septic Tank (Specify Requirements) ---- -------------- --- -------------- <br /> Disposal Field (Specify R.ecluirernents)/6 ------- <br /> VNIVECI_-TV-------AIC17-7-V--- -----4 <br /> 01 ------- ------IM53-A-1-4------ <br /> 6 ARox--------- <br /> ---------------- -----------------­­------­---------------------------------------------------------------------------------- <br /> ------------------- <br /> 7 ting-and-recloired-addition on reverse side) <br /> _"RK <br /> I hereby certify that I have��preparecl this application and that the 'Work will be done in accordance -Scm Joaquin <br /> County Ordinances, State Laws, and Rules,and Reg ulatiprs(6,fjhe Sari Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certi t a in the perFormpof the work for which this permit is issued, I shall not employ any person in such manner <br /> perform S Compensation <br /> as to �"coDe ubj�ect to Woi s Compensation laws of California.'' <br /> __:.. ------- -------- <br /> Owner <br /> Signed ---- ----- - ----------------------------- <br /> - lrkv------- Title ------------ ------------------------------------------------------------ <br /> By --------------------------------------- --------- <br /> -- - - ­:--- -------------------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> c <br /> i� 'f -, I 177W# <br /> Cj I c? 70_�_ <br /> _jA DATE -------57�� -------- <br /> APPLICATION ACCEPTED J,BY !R�- ---------- <br /> --------- ----------------- --------- <br /> BUILDING-PERMIT ISSUED ---'--+'--------------------==-----v--------------------------------------­---------------- <br /> ADDITIONAL COMMENTS el �__ts -------- --------------------P-1------------------- <br /> ---------- -------------------------------- <br /> ---------- - ------I&SP.--------I------------- -------- <br /> 1- -- --- --- <br /> ........ .... <br /> ------------------------------------ <br /> ---------- ----------- <br /> ---- --- -- --- -------------------------------------------------------------------- ----- <br /> ------------------------ -- --- ----- ---- -- <br /> I -- ---- - ---------!---------------------------- ----------------- _mer.-- <br /> - --- --- ---- --- ; _ ---------- <br /> ------ ----------------------- Date - ------- <br /> ----------I- ----------- <br /> Final Ins n b <br /> j------- ----:- - - --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6B Rev. 5M <br />