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` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT
<br /> X77
<br /> Permit No. --�- - ------
<br /> ,Complete in Triplicate)
<br /> :��.
<br /> I- t
<br /> ':date.Issued ---- --7�
<br /> d � M1 A
<br /> i fora permit f4
<br /> This Permit Expires 1 Year From Date)esus
<br /> AN
<br /> II `
<br /> Application is hereby made to the San Joaquin Local Health Districts p o}�co st uc and install ;the work herein
<br /> desrxikied. This application i� made in compliance with County Ordinance No. 549 and Aezis#mg:Rules.and Regulations:
<br /> } CE LAS TRACT:.= '--- -' •------
<br /> JOB ADDRESS/LOCATION _� t , ,$
<br /> Owner's. Name l �t�+-r--- �-�' 'v tic - K --
<br /> -----------------•------
<br /> VF l ry
<br /> __ ______ ______ _ ________ _ ____ _ !.!-_ ______._-______.__._____...
<br /> Address. _ 0
<br /> ---- ------ '
<br /> .�clty: !t-��
<br /> f ... . ;
<br /> Contractor's Name .°-- o �.`' 7PFione ,,�. I. _
<br /> License # Gel
<br /> f y
<br /> Installation will serve: ` `` I2es�derSie Apartment House'❑ Corrmmercial,.OTrailee'Ctsurt ,❑ '°
<br /> ,
<br /> ' 'f. Motel Other
<br /> 'Number of;tliving units Number of bedrooms 3 ___Garbage Grinder r t- Lot Size
<br /> Water.Supply: Public.System['a_nd namey____ { -'
<br /> �,
<br /> Character of soil to a.depth of 3 feet Sand silt 0� Clay ❑ Peat❑ Sancly Loam-❑ Clay Loam ❑
<br /> __.. _ , - .tib s �•,; .�,�.., � r : - - � ,
<br /> Hardpan ❑
<br /> do -e'[]i FE11 Material := If,ye5 type ,._ s
<br /> ..
<br /> .s._
<br /> (Plot plan, showing si' of lot, location''of sysfiem m relation to+wells, buildings, etc.,fmust. 'be .placed on'reverse side.)
<br /> NEW INSTALLATION: (No'�septic'tank`or seepage pi#-permi#ted if.public sewer is availabiezwithin 200 feet,) .451
<br /> '
<br /> PACKAGE TREATMENT SEPTIC TANK [ ]f' �4 Size___--X__.5-`".Y ---:= rt Liquid Depth _____, ----=------- ---
<br /> r Capaci - xTYP a --- 7Compartments _..
<br /> Materi I o
<br /> ,� :•
<br /> 1 f' '
<br /> Distance fionea
<br /> rest Well rr `- "'- Foundation Prop Line
<br /> '716 t = .
<br /> LEACHINGILINE ,;,[F]„ No.- of Lines Length ofg i ch .line--_ ---- Total Len #h=----- -._�_ ..----____--
<br /> . Box Tyke Ater IVlaterial __1f-7A- _-De.pth,Tilter' Material
<br /> ----------- --
<br /> ------------•--------
<br /> V 1
<br /> D�stance,to nearest Well -Founelation _ --_ _ Property Lrne,__ `..---------
<br /> SEEPAGi" PIT [ ] "" Depth --°_ Dia:meter � .�_-- Number' _ }}� ��- Rock Filled Yes ❑ No iLA
<br /> ❑
<br /> r tit r Rock �• :,
<br /> Water Table Depth s - ' �y � S ze' �
<br /> Distance to--nearest Weli°"' _--R =_Foundatian :_- t" --- s Prop*Line -----.-----
<br /> REPAIR/ADDITION(Prey.=Sanitation Permit# —Date - t 1 � `
<br /> Septic„Tank {Specify Requirements) - ri, ”,
<br /> ui, s
<br /> '' -------------------------------
<br /> Disposal�. ,i Field .(Specify. •Requirements); -- y
<br /> _ -----------------------
<br /> _ ___' '
<br /> y — ---- --- -
<br /> ---------
<br />.. --------- - ---------- ------ --r ----- ---'- - --- ------ "-------------
<br /> w` (Draw existinq pnd,required addition on reverse side) f
<br /> #: I hereby certify that I haver prepared this app Iication;.and that,.the-work-will be,done:rn acc rrdance with-Sinn,Joaquin
<br /> County Ordinances, State laws, brid Rules and Reg�eldtions of Ae'San Joaquin Local Hoalth,Distrtd. liomenowner or licen_' f
<br /> sed agents signature:certifies fhe following <�4{ .• K. �_ ' fi9 '`' I
<br /> "1 certify that in the performance: of fhe work for wlhich this permit is issued, 1 skull nbt:emplo�yy person,in such manner ., k
<br /> as to become subject to W.orkman's Compensation laws of California.
<br /> Signe - .. l
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<br /> 7 �
<br /> I f _ ,_-� Own �
<br /> ` LTi ' xt}� i
<br /> -a----------
<br /> (if
<br /> �0ti
<br /> BY - �," "`
<br /> If other thaneown ti - ---------- � tle - - ----------
<br /> --------
<br /> - „
<br /> ' r
<br /> w FOR REI'AitTMENT I7SE ONLY ,. v
<br /> APPLICATION ACCEPTED BY - " ' ': = BATE ..__ �. ?.
<br />�'-.<•. BUILDING PERMIT ISSUED °� t ----- �------------
<br /> � --------
<br /> -----------------------
<br /> ADDITIONALDATE ----------
<br /> ----------------------------------------------
<br /> - -
<br /> * Y _ _ I
<br /> COMMENTS _z___.___
<br /> 1
<br /> .� _________ _______ ___________ ___ _______--------------------
<br /> _ _ _- -----------------------------
<br /> ___ _ ._____--____ -- __.______- ___._-_----------------------
<br /> ---------------------- _ .___ -______-.
<br /> Y _._____.._. _____________ -.._ _ _____ _ ___.___ .------------__ ______-
<br /> ---Date . --------
<br /> --------------------------------
<br /> Final lnspection•by: ----------'---------
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> E .H. 91 '68 Rev. 5M
<br /> f
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<br /> '. ',ik. ..-:.L1 '."ids":....-.d. C
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