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<br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT
<br /> .................)ZAt' _..__..._._. - � Permit
<br /> (Complete in Triplicate) � No. .....................
<br />..--............................................. .. This Permit Expires 1 Year From Date Issued 'pate 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 /> JOB ADDRESS/LOCATION ............... ....... ---.--......CENSUS TRACT ...............
<br /> O vne�'s Name ... _....... .. -- .Phone�;,sr-+�.
<br /> Address a :_r� .:1'. i �w'- ity`,: 1 �' ._. `
<br /> Cpntractor s Name :?vC:i ,. :: -- - LicGr►'e"# / 6�Y :fit 1'i#3... �
<br /> i q ;
<br /> �A
<br /> Installation will server Resides ce--M ApartmentHodseO Commercial Otrailer Covrt
<br /> i .._ _ .. .. .. . .. .,. ,. Mote10'4ther`�_::::`::: _._ .._...... ::r-i=-- •;• a �:-. �,.
<br /> Nwmber of living units: �' Nu nber of;Gedroorr)s Saarba6e,Grinder LotSixe._,°
<br /> i Private:
<br /> Water Supply 'Public Sxstem and name ,,... ,r.:c..a: a.: , „a.
<br /> Character of soil to'a depth of 3.feet. Sand j] Silt❑ C-Jay ❑ Peat Sandy.Loam Clay Lo m ]
<br /> `..... a s
<br /> Hardpan []. Adobe Q Fill Material If}res,}ype �
<br /> (Piot, plan,�.showing..size.of-lot, 1.ocatian-of.sys`.tem;,in-relation,.to snel[s, bu.ildmgs etc ,;x�vst..be..pla�ed on,.ravgrse':side.l
<br /> ,
<br /> r see a it perm ttetl i# ub
<br /> NEW INSTALLATION ; (No septic tank;o pig. p'.,-p• Ei,._ rx .-,-
<br /> Itc`s wer}s available within,2Q0 feet,).
<br /> �-
<br /> PACKAGE TREATMENT [ ]: SEPTIC TANK{ Siae . ? __ Ltqu epth :: ,
<br /> y^� s ,d D `. }
<br /> l Capacifiy - - TYP®f ��_ Mc tergal t No Corhpa6met�ts . _ ... r
<br /> „-
<br /> Distance to nearesfe Well es [ Foundation ,��a �� Prop Eine t
<br /> LEACHINGLLI�NE ' j IVo of Lines Length;of�itis lrn$ Total ;Lent�i FZ. ...._
<br /> •
<br /> i . ._... .. D" Bax :f':'. li;,- iltet'`N1;5teri#ah..":`':: .............. ...,......,� ...
<br /> TyWe'Fi:fti r '1VlFatenal: _ Abept F' :.......... .
<br /> - Distance--to nearest: -Well, , Fovndd#fln Q � Property'Lir1e�� :"=:: .._ A
<br /> SEEPAGE.PIT [-••]. Depth• _:s.::.:: Diameter .._.s'..'•Nvri�bar s.:x= :Rack Filed �•�!es�'Q•� No [ _
<br /> `D�stanc$ to neo>'est:Well 5 1=o�nclaf�on
<br /> Prop. Line '--•-
<br /> r., t :,.....
<br /> REPAIR/ADDITION(Prey. Sanitation Permit# .- _, Date " '
<br /> �epfic Tank (Specify Requirements) .. , - - i _....R..R° ........... 1
<br /> Disposal' Field (Specify Requirements) `
<br /> ,3...
<br /> [)raiN ekistirig,arid required„addition on reverse side) •„•��,,,•„--.-•,_,� ,-..--
<br /> I F ereby certify that I have prepared this application chid tacit :the `work will be done 'in accordance with San Joaquin,
<br /> Coiiintyiia.Ordiites;'Stdilb Caws; ani "Rules and-Reguidtions'of'the Son']oagkter-'Lcca! Heeiltli pistriEt'"lWorina o�4ine�br liter-'
<br /> sed agentssignature certifies.the.followirig:.-;.......r_.._.,....
<br /> ,...?.. .,. :,,....
<br /> "I icertify that in the perforrnanc'e of the work'for which this permit is issued, I shall not ernplby atsy parson in sucli mdanner.
<br /> as to become suiijat o o�lc" n's' ompena#ion laws of Cali#orn�a , '
<br /> Sighed �. ., /:r�.�.. ..,r., t.C�
<br /> fljnr er : ,i..
<br /> i
<br /> By •.
<br /> ,.. s• i ;� x title•- --��� _ � �ty..
<br /> (If other than 6wn6r) r
<br /> 1`01t OEPARTMENT SE ONLY; f
<br /> APPLICATION ACCEPTI"D SY ...
<br /> .. .. __ •_ �_ DATE .'r�?'�.i�'.�__ ....
<br /> BUILDING,PE2NIT..j$SU D .. .. j:-.
<br /> ADDITIONAL COMMENTS- .._ .... .....
<br /> ... F _. ............... -- -... ,: ...... ----- r.:.. r._:_ r.•.
<br /> < �.. t...... i_.: .�..... ... l
<br /> _ _3..... ..... -Daipp ,J._.
<br /> I F' i-In a
<br /> .......................
<br /> 'ti n�b ._ ... . .::. _. ._.�.....,...}. .,. �.Y••_
<br /> ina SP c a ..Yi.a:-... _ .. .. _ .. ,i :.... ...-�-- --�r..... :::_I::...:::.:....i,-.. .a ..� {'��,
<br /> SAN JOAQiJ T ;DIS RICT 1
<br /> 13 24 1_ .&Q aa., ca. 7/72 3•A'I i
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