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-r,`JR OFFICE USE: 4MIT.
<br /> APPLICATION #AOR .SANITA,'1'tAN
<br /> Permit No
<br /> rnpl fe ln.Triplicate -
<br /> ••••1•-:. I d ,. .. A , , .This Permit pare t Year I+rom DoNls :ustf tate lasued %5................�G
<br /> Applicafiori`i's:hereby irtiade to f}te'San Jcaqum Local`Realth;District for;a permit to: construct and Install tho work 'herein !
<br /> described!This appiicat,ori is made in compliance with'r '0 d' '° No".•544,6nd~existing` Rules and-Regulations. I ;
<br /> i i j t I i t � ti
<br /> .JOB, ig
<br /> ADDRESS/LOCATION :. 1 �-f.j .- , _ _ f s s CENJ ; k
<br /> - l i .�._ S� TRACT ............ ----- -
<br /> Owner's Name - _ S .._. .-. .. ,
<br /> t
<br /> Phone
<br /> ISS } ! ! 1 .� r City -
<br /> ddre
<br /> �.nb'n.aSs�. xxa.y �x...4' �x..w n k�:,a w ..;r � •,,,- -e 5 .. _,.. �
<br /> Contractor s Ngme .. _ :License# .�� �7�i , -: Phone ,
<br /> E 6, d ._.4 ..i�.a..�.r. ..;�.,. ...... •st . .... ......... ....- .
<br /> lnstallatian will serve: Residence Apartment House fl ]Commercial OTrailerCourt' 10' I
<br /> ' , � ^ x'�,.• -,� ;��.c:�e3..,� .,f .z .�r..:.tf -i-s � �.. •� s r.-'�a�. x-.. �'kf �
<br /> f Motel ❑Other .......................... l !Sy 333 it y9(}{ t
<br /> , i i Y� .�...��.s y. � k E R• .a ,i...e. � k � i Y
<br /> NUmbor of iivrng unt#s: ..:'� =Nurnber of bedrooms _` . ._.Garbage:Grinder t Lot Size '
<br /> It
<br /> Water;Supplyi'Public System urtd nQmeg"^ '�' ""� k`
<br /> r ° 11. # €-- i � .A ....._d -.-s. . ---.{ ... -- .........Private
<br /> Character of sq •.to a.depth{af 3=feat : Sand i] k�Si t.� «Clay{] :Peat❑ ' Scndy''L'oi Tl clay Loam.0' s I
<br /> .5. .R�,•,,.. ,: _ .- ' n,sr .,.,:, HartlAoleOFilzan p - iolIt 1.
<br /> yi
<br /> {Plot pian °`shdw rig size of Idt; locatron`"of sys6r lin rselatlon to wel1s,�buildings, etc, must be placed,an reverse slde.�)
<br /> f i t i J i �•' € ... { : a g. .
<br /> ' NEIN INSTALLATION:�� {No septic tank or seep age 'p'it'permitted If�sublic sew"edIs available within 260 feetj' z
<br /> ' P;4CKAGE TREATMENT ( ,SEPTIGL'TA�f1 ""l s �* r...ga orie l /Y.. .. xY:_° ." _:"
<br /> [ Liquid Depfli`
<br /> will
<br /> ,>
<br /> k.. ... -. Copocify..�.12�? ' ._ ,_Type.? -4 :i,.Materlal'._ � Na: Compartments`y :. ° --. •6
<br /> T
<br /> Distance.to nearest Well y Imo- .. ..Foundation . ._1:f7.:x_....';- Pro Line: .Lo
<br /> LEACHJNGLINE [� No= of Il�ne's l �� • 4 rg 3 I } `�< k Total Length ... `. _.
<br /> Len th of each line.:... ------
<br /> �TY eASF �r..,.yA,. x' ��. t Depth .Filt t �, f Z
<br /> i l D'�Sox r Niter lUlaterial% _ er Mdterial ./:I
<br /> A t Distance to neaiesit it ' .f _1 Foundation; _�._` =Property Urie ........
<br /> ``,[' Depth, . r _ Diit33me3er Number i -a----- ` .. Rock Filled Yes lam, No
<br /> Water Table Depth t :Rack Size
<br /> „ .
<br /> ( ' Diston to nearest: ,Well I'°•lt� � :...'I _... Fouridoticn` %:.�_--_r Prop Line _- 0
<br /> t l
<br /> REPAIR/ADDlTICN lPrev: Sanitation permit g4�° ,. }}
<br /> k I a six•*+- _,ctFa ... .. .......
<br /> fSeptic.Tank ispeclify Requirements) '- 1. -• . `Y" p......' {i{ :~ .: }j.. ,s •.,. ••_ ........ {.
<br /> Disposal' Field {Spec{fy ,i equrements}., �... ... _.... . . .. . t= ...................
<br /> � � � $ � to � � ' .- -------------------- . -� �_... ._ .. _. .__...... . : .. ,.-� -- �'- --
<br /> - I i
<br /> {Draw exi§ting"arid eqursecl addi4ion o�ii ieverse side► r
<br /> ! leerehy,,certify;that 1 . ave prepared.this=appll aFien ar{d that-,!hes work k will be done In atcarda�ice wiih San y leaquin
<br /> County Ordinances, State Laws, and Rules c�ndhRegrilatranstOffthe Sdn Joagtiin.LocafNealth Distrld.-Horn.-owner or Ilcett
<br /> sed agents;si-9nature t', AiiW fhe4followirig:
<br /> l certify-that in the performance-of'the:worlt,for:which--tins°permit,icfssued,'l,sh`ail not''emplo'y any person in iucl,'nranner
<br /> alto become subject toWorkman's Compensation laws of Cdlrlornia " •_ _ ,¢ .•,.: , a
<br /> y Signed i .. t I ` 3 Owner
<br /> S
<br /> { ` i
<br /> - r
<br /> y ,.. in;.--se >-r ?.�_ : .
<br /> - -
<br /> €. Ilf otter than owner}a ,me vrom E.yS k :n a �.Qi�«r;-. , y
<br /> aDkPARTMENTIUSE.ONLY-,1: ., i -�,� i' - , ,�r, . , % ..
<br /> 5r
<br /> ON,ACCEPTED 63 _.- ::.__ AT :-�`. :�: T
<br /> APPLICATION, )_ - r ---- M .. ,'
<br /> BD.ILDING°PEi2N1IT iSSUia]- ---------•------.-. ------------------------------------------------------ .._._..{ DATE ... ......................
<br /> ADDITIONAL COMM
<br /> E.NTS ----.._.--•..........
<br /> -•-------------- ........ ------ ------------..._ --------------------------------------- ----------------------------------------------------------------------
<br /> r
<br /> ---- ------------------•---------- -•--:.........
<br /> .
<br /> Final Inspection b -------------------------------- Date ....-.--- `' -------
<br /> iH 13 2L 1-68 Rev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M
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