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APPLICATION FOR SANITATION PERMIT it No7l��­7 <br /> Perm <br /> F OFFICE <br /> S <br /> - ------- —. <br /> ---------- (Complete in Triplicate) <br /> :t­� I \,"", Date issued <br /> ---------- --------------------------- --------------- V ` <br /> This Permit Expires 1 Y6ar From Date issued <br /> - ----- ------------ <br /> i j <br /> --------------------------------------- -------------- and install the work herein <br /> made to,the San Joaquin Local.Health.District for a permit to constructu'les and Regulations. <br /> Application is hereby .e in compliance with County Ordinance No. 5A9 and existing R <br /> described. This application is mad <br /> CENSUS'TRACT ----------------------- <br /> _F-------------------------- ---------- <br /> JOB ADDREWLOCAT.10 ---------00 - -----------------Phone ----------------- -------- ---------- <br /> Owner's Name - ------ <br /> ------------ <br /> City <br /> Address -------------- -11-4-1.73-- Phone <br /> d License <br /> Contractor's Name t oTrailer Court "El <br /> ssicienc�X�Apartrnent House'[] Commercial <br /> Installation will serve: Ri, <br /> Other -------------•------------------------------- <br /> Motel <br /> Lot Size J --------------------- <br /> 7-1 -Garbage Grinder ----- ---- <br /> Number of living units:-_I------- Number of bedrooms ----------- ---------------------------------------------Private <br /> ---------------------------------------- <br /> Water Supply. Public System and name _�------I -- <br /> ---------- ------ lay F� Peat M Sandy Loam ,[] Clay LoamE] <br /> ,&t Sand'h Si it❑F-� C <br /> Character of soil to a depth of 3 feet: ---:In-------- <br /> Fill Material ------------ if yes,type --------------- <br /> H'ardpan Ej Adobe <br /> reverse side.) <br /> S, c. must be placed on <br /> ocationf system in relation tow lls, buildings, <br /> (Plot plan, showing size of lot, I., 'Wed if public s..ewer is available within 200 feet,)NEW INSTALLATION: (No septic tank or seepage pit perm -------- Liquid'Depth ----------------- --- --- <br /> I TANK:[ Size----------------------------------- <br /> PACKAGE TREATMENT [ I SEP No. Compartments ---------------------- <br /> I <br /> ----- --------------- <br /> Material----------- ---------- I <br /> Capacity ------f-------------- Type -------------------- -----------'Pf6p, Line ----- ---------- J0 <br /> fi�C? I Foundation --- <br /> 7C rs Distance to nearest: Weil ------------------------------------ rt I Length 1____4_0---------- <br /> To -- 10 <br /> a <br /> LEACHING LINE No. of Lines <br /> -------- Length of each line . <br /> __$/ er. --------- f q_�__Depth Hite MQ f <br /> V Box &.aO... Type Filter Material ----------- -- Property Line. -57--------- <br /> Foundation ---- <br /> Distance to nearest.—Well—ZiM Yes No 0 <br /> 1 4 / Rock Filled <br /> PAGE PIT Depth Diameter -------- <br /> r <br /> SEE Rock Size <br /> r . <br /> WC1 Water Table Depth --- Prop. Line <br /> Distance to nearest: Well ----- ---------------------.7-.-Founclation -jam--- <br /> Date ---------------------- ----------- <br /> (Prev. Sanitation Permit# ----------------------- -- -------------- <br /> REPAIR/ADDITION ------------ --------------- <br /> ---------------- ----------11 <br /> Septic Tank (Specify Requirements) ------------------------------------------------ <br /> ---- <br /> --------------- <br /> Disposal Field (Specify 'Requirements) ------ ---- <br /> ---------- - -- ---- <br /> ----------------------------------------------------------- <br /> ------------------------------------------------ -------- ----------------------- <br /> ---------------------------- ----------- ---------- isting and required addition on reverse side) <br /> (DraWex ____4--.- <br /> !- c I lication and that keep ork will—be done in accordance with Son Joaquin <br /> I hereby certify that I have prepared this 6pil ns of the SJoaquin LOCCIOHealth District. Home owneir or leen <br /> Ordinances, State Laws, and Rules and Regulations a <br /> sed agents signature certifies the following: lay any person in such manner <br /> "I certify that in the performance of the Work for which this permit is issued, I shall not emp <br /> *m ct to W <br /> as to beckman's Co ensalion laws of California." <br /> 1n>? <br /> 'c <br /> owner <br /> ------------------ <br /> Signed Title ---------------- <br /> k By ----------------- ---- <br /> �f-Ae---- - -- <br /> (if o h r an ner) FAR DEPARTMENT USE ONLY <br /> - ---------------------------------- <br /> DAT <br /> ------dam--------------------------------------------- <br /> -- <br /> A---p--p--L-1-C- <br /> -A---T--I-O--N----A---C--C--E--P--T--E-D---- <br /> -B--Y- <br /> ------------------------------------------------------------------------------------ ----------------------- <br /> -------D---A--T----E <br /> BUILDING PERMIT ISSUED - -------------------------------------------------------------------------- <br /> -------------------- ------------- <br /> ADDITIONAL COMMENTS --------------------- <br /> ----I------------------------ <br /> -- ---•---- <br /> ------------- <br /> = <br /> ------ <br /> - <br /> ---------------------------------- ------------- <br /> ---- ------------------------------------ ----------- <br /> -------- <br /> c-- <br /> ---------------- -------- ----- - -------------------------- - ----- --- Date _XO.A <br /> ?/----- <br /> ------------ <br /> X----- <br /> ---------- <br /> ---------- - <br /> - - - -- ------- <br /> - ------------- <br /> Final Inspection by SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r W Q 1-'68 Rev. 5M <br />