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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �r
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<br />.................................-.........---..._...._- Permit No.
<br /> ...1-�..�P...
<br /> (Complete in Triplicate)
<br /> This Permit Expires 1 Year From hate issued Date Issued .......
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<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 /> JOB ADDRESS/LOCATION .......------. �...... .........---•....... ...................... .............CENSUS TRACT ... ..........
<br /> Owner's Name , ..I� ... C`u rL� �! _ .....�... . Phone j, ....... .:.....
<br /> ..............
<br /> -- . •--- . `City. �._... ... .. JJ .....Fddess .
<br /> C�ntrgctor's"Name :'. i-`. . =r✓q � . - - ,................. liceitise` Ts� Phb�i2.3 -f '.
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<br /> Installation will serve: Residence Apartment House 0 Commercial DYrailer Court. a
<br /> I c..,... y.
<br /> .., .. .. Motel:�-Other _ , ............. •. _ :. • °.:• �. ; � .:.._. ..�.. ,
<br /> Number of living units J..• .: Number of;bedrooms.,. _.,,':�-_Garbage..Grinder-------- ___ Lot.Size 't� •- ... - ,
<br /> \later Supply: Public System and name _ : ;Private E
<br /> Character of soil to a depth of 3 feetSand❑ Silt❑ Clay Peat Sandy Loam.� Clay Loam w
<br /> 1.
<br /> Hardpan ❑ Adobe ❑ Pili Matarial _ If yes,type .............
<br /> j ......
<br /> (Mot plan,,showing iiia of lot,.location, of system'.in relation to_wells,,buildings,4tc. must.,bd..placed on_.rev erse side.)
<br />` NEW INSTALLATION (No septic'f.nk or seepage pit permitted if public sewer;is available within 20., feet,)', w_;
<br /> PACKAGE TREATMENT; [ I- SEPTIC TANK t ] Size Liquid Depth "
<br /> ' t - V�terial--- No
<br /> Capacity --` `-`---
<br /> e :
<br /> Type Compartments
<br /> b xiPDistan�ceA to nearest Well
<br /> Foundatiaro
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<br /> LEACHING' No. of Lines .-:_...�_______________ Length a ea ane.._ :....... _ Total) 'length ; --• ;
<br /> ' Di-Box'` " "Type'F.ltiW Material".. ....... --•-'•-Depth '•Filter"Material" .............� '..........................-
<br /> ----;...._._
<br /> I Foundation .... r
<br /> °r''-Distance to; nearest: Well� ...... .
<br /> : •Poe ".� -
<br /> }
<br /> `..Rock a-Filled .Yei ;.., No_0
<br /> De th Dicma#air,,.:--':.,...
<br /> .Number L7,
<br /> SEEPAGE PIT :-I;•j T_..` p •• - �
<br /> E .. r .Water,.Tabl`e...Depth .... Rock Siie
<br /> 'Distance to nearest We4l . - N- i' Foundafion trop krne .
<br /> REPAIR/ADDITION(Prev. Sanitation Permit --• `Date ` 1
<br /> !Septic Tank (Spedfy{Reg6irementsy �'••� ` -; ;
<br /> -� w. h � ,.r.. . -
<br /> ;Disposal Field (Specify #Requirements) -• ..•- �` . ...............s ,
<br /> - j - _ �.. .___...... ... _._ .. -----^ .. .....................
<br /> a
<br /> .........................
<br /> f_ _ 5. i.,...}.
<br /> {Draw existing and required addition on revere side)
<br /> 1 hereby certify that IF have prepared this application and that;the;work will be�done in accordarite with Sart. Joaquin
<br /> # Cdunty Ordinances State Law-s'.';and"Ruies'cind;Reg'ulations'bf'ti e'San'Joaquin"local'Health;District: Hbrrie'ovine or titan
<br /> ° stagents'signatuie certifies.the following:. ?, ,., I .. _?. .. ,. ....,�..,,.. ..._ ' _a
<br /> certify hat in,the perforritance of. the'worik for which this permit is issued,t l shall not employ any parson in such manner
<br /> as°tn become sulale'ct to Wo�kman'x Cori pensaltion"laws f�Cd ifornia.' ;
<br /> Signed `. :: ............, .....:_: Owner
<br /> BYE .. ............ 4. �- .f__ F ... ._ .. •'�'itle ._ ¢ .. ; ._
<br /> (if other than owners i i _ :....
<br /> s F R DEEPARTM T USE ONLY i
<br /> r.... .
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<br /> APPLICATION ACCEPTED BY _. ,.�
<br /> .. ---• --
<br /> { J
<br /> BUILDING ,PERMIT1SSUE D _ E
<br /> DATE r" � '•
<br /> � --- ' --• -. .. ... � ... _ .. DAT .a ::._ � ;...---,- --•
<br /> ADDITIONAL COMMENTS ., i:_.. S
<br /> !_ --_ _ =u �.^'T^+a: _ -_ !. .� _—;�—zsa.'-;.acus-ae +... k fi' ._ „ "R'_- ; . .......
<br /> '.'�.'_.
<br /> _ y
<br /> ., - S
<br /> : — #
<br /> a.Rnal Inspection.bY. -
<br /> 4 .... .,._. .M.. . SAN JOAQUI LOCALw,HEALTW DISTRICT -a...n. .� �.. `� a._`rte,,' ..I, , •.
<br /> c u 13 24 1.-AR RAV. 5M 7/72 3 LK
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