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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> ...........­..........t��... <br /> (Complete In Triplicate) <br />:_.:......,.................--•••-• ...................... Doti Issued ..... <br /> This Permit Expires I your From Date Issued <br /> ..................... <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 /> C <br /> ..................CEI7 Pl <br /> NSUS TRAL7 .-.........-........... <br /> JOB ADDRESS/LOCATION I — P <br /> . . ......... ........ ............. <br /> .........Phone ...�L/ <br /> ......... ----- ........... ........ ........... <br /> Owner's Name <br /> Address ........... ................City <br /> o 6-5wa-0.7 <br /> V_ IV.S......................License # .......................... Phone -_-_------- ........... <br /> Contractor's Name .. ........... <br /> Installation will serve- Residence XApartment Housed Commercial oTraller Court <br /> Motel [3 Other .................. ......................... <br /> d -Lot Si . ....V..,3.......... <br /> of bodi�6mi73-7.=Gdrboge Grinder ............ <br /> N <br /> umber I------- Silt : :...........Private 0. <br /> 2... . .. <br /> Water Supply: PublicSystem-'and-name- ........................ . <br /> -toy 0 Peat Sandy Loom 0 Cloy LOOM <br /> Character of soil to a depth of 3 feet: Sand El 0 ..0 <br /> oil Adobe] Fill Waterial .....�� If yea,type ............... ............ <br /> jPlot plan showing size o <br /> '� f Jot, location of system in relation, to wells, buildings, etc. must be placed on reverse *149.) <br /> NEW INSTALLATION. (No'septidtonk or seepage pit permitted.if-public sewer is available within 200 feet,) <br /> ....�LI4-uld Depth ..........7:..... <br /> PACKAGE TREATMENT SEPTIC TANKi V .................. <br /> . ,kMaterial No. Carrspartments -• l�.........Z <br /> = Capacity t _ Type .4& <br /> Well ..........:............Foundation -.4020........... Prop. Line <br /> Distance,to nearest. We <br /> A"_1............ Total <br /> ------------ ...... Length of each line <br /> A <br /> LEACHING LINE, ial 4A_1A._,Depth,Filter Material ....IS.Ir.................. <br /> V Box .... Ty <br /> ,I`Type filter Mater Line <br /> ..... Foundation .....1. .---........ Property <br /> Distance to nearest: We <br /> -Filled Yes [3 No <br /> ........ ..... Rock 7 <br /> ............... Number .............. <br /> SEEPAGE PIT D ........... I ...... Diameter <br /> I ....�i....... <br /> Water Table Depth __........hock Sin -------------------• <br /> ... ....... '.Prop. Line ...................... <br /> Distance to nearest: Well ........................ -::-Foundation : <br /> REPAIR/ADDITION(Prev. Sanitation"Permit# ............................................ Date ------••........ <br /> ............................_-----•-•.............. <br /> Septic Tank (Specify Requirements) ..................­­­ .................... ................ <br /> ........... .......-.1.............................. <br /> Disposal Field ISpicify Requirements) ----------------------------------------------- ................................ <br /> ............................. ...... ........... .................. ........................ <br /> --------------I——------------ ­-----------­-: -------- ............ ................... <br /> ---- . <br /> • ............. ................ <br /> ------------ <br /> ---------- <br /> --- _----------- ------ ­--­- •-----­- ------­----........................... ....... .............. <br /> {Draw exist <br /> -------------------------- ing and required addition on reverse side) <br /> itation and that the-4mork will be done In accordance VAth Son Joaquin <br /> by certify that Ithave prepared this <br /> I herel Opp, <br /> hereby <br /> County Ordinances, Stiite Laws, and Rules and Regulations of the Son Joaquin Local Hoal&District. Homo 64iner or licen- <br /> sed agents signature certifies th616116,Aoingt <br /> such manner <br /> "I certify that In the performance'af the work for which this perridt-Ij issued I shall not employ any person in <br /> California." <br /> as ta.become subi Workman's Co"sation I f <br /> eo-to.Workrr sof <br /> ........... <br /> 4 ____.... <br /> Signed ...ID,----k. .......... .....1-1... ... .... ......47. <br /> .............................. <br /> By ------------------------------------------------------------ ----------- litle <br /> Of"other than owner) <br /> FOR EPARTMENT USE ONLY <br /> 1E <br /> /7 <br /> D -737 <br /> ...... DATE <br /> - --------- -------------------- -------------------- <br /> APPLICATION ACCEPTED Ely ------ _DA E-------- .... . .... <br /> ....... ......... ............... .......... ...... . <br /> ---- --------------- <br /> (V, ------ <br /> o-­,.ADD TION COMMENTS --- P R ......... <br /> 4,. BUILDING PERMIT ISSUED <br /> Am <br /> e <br /> 4.1rt lr ...... �n 1,13........ --- K. <br /> -- ---- -4'e'- A fW7 <br /> ek.... .....i-_,___4. *_�Y�-,//A,?�Lm. ..... <br /> e J.-�* <br /> .. ....��e Ila _!�Kv/ft- <br /> ......Date <br /> N ec"tion by: ------- . .........---••--•-•------------•--•--.........--._..--- <br /> ------------------ -------------- <br /> F'iAcil Ins --­---- ------­- ------ <br /> EH .13" 24 1`68 lb--V ---�OAQLIIN LOCAL HEALTH DISTRICT 877 311' <br /> 5M <br /> 45 AN 7 <br />