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FOR OFFICE USE:
<br /> -
<br /> --.-.-.-.... APPLICATION FOR SANITATION PERMIT Permit No. 7
<br />............. � --..-........._-..- .--..........-------. t
<br /> (Complete in Triplicate)
<br /> .........................•-•....-.-..... ............ �C -76
<br /> ............. .................•---.........-, This Permit Expires 1 Year From bate Issued
<br /> �' Date Issued .,,�'.............. I
<br /> C q-7—(?,o-45
<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 /> IT 97 �aP r -. 'r %.-.22'1.............CENSUS TRACT
<br /> .108 ADDRESS/LOCATION ,/ll�i _
<br /> Owner's Name :. -.~ .11 �tL_ ..... : = - �--�• ,. - ,-. Phone
<br /> Address - City --- ! s�Cp-
<br /> Contra`ttor s Namef=:: Gt�.� `" `. :: Liceh..Se...#a� :;,.Ph�51rte "1- �U,7
<br /> - ..
<br /> Installotion-will serve v` Residence-,L)•Apartment•Houseo-Commercicl `TrailerCourt:-O "'
<br /> Motel•0 Other
<br /> Number of (wing 'unit's:...............Number of.bedrooms„ ::_... .:Gafbage Grinder.,.
<br /> Water,Supply-:Pubt ic System and name - ' _ - Pr
<br /> :...
<br /> wale
<br /> 1
<br /> Character of soil to a depth of 3 fee#: $and�; Silt❑ Clay; ❑ Peat❑ Sandy Loam � Clay Loam Q
<br /> Hafdpan ' Adobe o. Fill Miiterial If yes,:type _-..-
<br /> ❑
<br /> (Plot plan,,showing,size..of lot, -location..of system.in, relafi.on, to wells,.buildings, etc_.;muSt..be...placed on'reverse_side.I
<br /> NEW INSTALLATION Ptic rta. nk , 'pit availbiewithin 200„#•eet)perriitted ifpub!)c se .......
<br /> P TREATMENT' E SEPTIC TANK I j ; r : Size - __ Liqu Dept
<br /> ACKAGE 'd D
<br /> Capacity ..,7ype`i�,E' tSMateriel._ No Compartments .... 1
<br /> :. ..
<br /> Distance to nearest. Well ( i... _ Foundation l.. -_- ..... .- Prop. Line: ,
<br /> LEACF{ING, LINE � ) No. anes Lengfh of ,each fine _ _ ... Total Lerigtli° __. i/
<br /> D' Bax :-I: "Tyne Filter:Material"lbepth';Filter hllaterial' .. - •--
<br /> i f
<br /> /i
<br /> .. Foundation'- • -- ProP �Liae `�J- �---
<br /> --•.�-... � Disane to nearesti-Wel • -. _�-�:.. �Y ,
<br /> SEEPAGE PIT ;[ 7 Depth r-�Dicsmeter ;R_,.= Number _ s .. Rock Filled j Yes ❑; ..No Q }
<br /> 4— s ,-- .,..Water Table:Depth _ .Rock Size .,.;
<br /> 2 Distance to`nearest Well ` '" Foundation Prop; Line -� i
<br /> RIsPA1RfADDITiO j i # Date
<br /> N(Prey. Sanitation-Permit# -�
<br /> ISeptic Tank '(Specify'Requirernentsl ......-.- ! A --°"'""� ' "�- r ----,
<br /> I �- S. . .,.- ....:..... ... � ..-,;..�. ., .... i fir � .., ._. .. .. -�s
<br /> Disposal Field (Specify Requirements} -- -----:- --..-.- _a_.__ -....--_-' -•- 1
<br /> .I :(draw existir5g and regvired addiflon an
<br /> w,
<br /> I hereby certify thc't I have prepared this dppl'' ation and that:the work will be done; in aeeordaeice with San: Joaquin
<br /> CountyOrdiadnces; Stafe Laws, ...."Rill""•` d Reg Al ionf of"the 5i�iti Jobqu�n'Udidl Health a�istricf:Hoiitie'oiNmee°'or iicen
<br /> sect
<br /> agents;sig nature.certifies.the.follow:rig:. - - •;... ,... l.-...•. -.•.w..;
<br /> i rcertify that in the performance of the work for which this permit is Issued,`I shall not employ any parson iri such manner
<br /> as'to become subject• rkm Compensation laws nl' Californla
<br /> Signed r ----", - ................ Owner �..; R.,...
<br /> }
<br /> ay; -- [ ... : :... : ....: :::.:: .:. ` _ Title ....F _ i
<br /> (0 other than .owner)
<br /> OR bEPARTM t USE ONLY:
<br /> APPLICATION ACCEPTED BY
<br /> DATE .. ..
<br /> BUIL-DING:PERMIT:ISSUED .................. i .... ...•- :: :_-::: ;..::.,..DATE
<br /> ADDITIONAL COMMENTS : r ;
<br /> i. $ :. .....:......<.. .qa•��., :.,.......... •. -... ........... ..............
<br /> J.
<br /> t
<br /> '-•-•---_ -.. .................- ' -- ... .. .. - -- - - —_i: - l - - -- -- -t- - -- ---- - -- — —_ --fix
<br /> _ .1.-i7ate R ....�......�_.
<br /> - •. _
<br /> Final Inspection by: - •.••, ...-, .•..,.......
<br /> i. _
<br /> u _.___ ...... ..�...•._.
<br /> }SAN JOAQUIN LOCA HEALTHY DISTRICT
<br /> _.. 7172 3 M
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