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FOR OFFICE USE:
<br /> ' ,i APPLICATION FOR SANITATION PERMIT
<br /> :.... ... .. ,: ._... _ ........ Permit No: .. ..3:..3
<br /> (Complete in Triplicates Dete\lssued .S............................ This Permit Expires 1 Year From Date Issued
<br /> D e Issued .5.`�_'.7,3
<br /> ' Application is hereby made to the San Joaqu.in.Local health District for a permit to construct and in all the work herein,
<br /> described. This application is made in complian"te wit i�Cou y brdinance No.•,549 and existing RuleMand Regulations:
<br /> JOB ADDRESS/LOCA TI N .._. '��I'Q� ------�YYa7_�`'?...�....... C�.C� ........ ..........I---------.CENSUS TRACT .........
<br /> _.
<br /> o �..�,,,... ,(� ,.,.��.. --.�._ -....mac -..k ,. ....a
<br /> wner's Name_ G ' .. .1` / ,e./. ............ .. ..Phone.
<br /> i Address �. City/ J _ ..................
<br /> i -�-
<br /> Cdnttdctar's Na 'e :_:'_:':`-; a'TQ_':._� '.r " � .License'.'# �+1 .'_ Phone ,�;
<br /> Installation with serve % Residence;❑'Apartment WouserC] Commeraal ❑Trailer Court
<br /> Motel ❑:Other•..._ .. ' ......... �. . ....._.., .
<br /> i
<br /> Number of Iivi g units•.-_------- Number .of bedrooms . Garbage GrinderP Lat Size,'`�Q/ ._: .
<br /> Water Supply.: Public System and name _--___.--_-__ Private
<br /> .. ,
<br /> � i • � .. ..i--- fir, .•� - ., x
<br /> Character of soil to a depth of 3 feet: Sand Fj Silt❑ 'Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ - l
<br /> - Wardpan ��`_A ?Adobe ( FII Matec�al If yes; type .......... -
<br /> (flot•plan,,.showing.size .of.,lot,..location. of, system.in; Icition..to,.wells,. buildings,•,etc...must ,be..placed .on reverse..side.);
<br /> NEW INSTALLATION: (No septic tank or seepage pit.psrmitted i# p i;lic sewer is avalable within 200 fat,) w. I
<br /> ru / 1 i
<br /> # PACKAGE TREATMENT [ ] 5EPT:f C.TANK .Size,,, f�!� � ._ _ Liquid ;Depth
<br /> k I Capacity . ..... Type.P,�s . Material. jlls� l No: Compartments` .......................s �l
<br /> f
<br /> Distance to nearest: Well .._.._.. �%-------- --------Foundation ...�J,7 ---- Prop. Line . �...---•-•:.•
<br /> LEACHING EINE No. of lines ..._/__,__.:.__.- Length of. each line..` Qf __. `Total'Lengtii ..�1�, ..............'.
<br /> J 'D' 80,l�d rf1`Type Filter Material� & epth; Filter Nlateritsl °1._...: ` ...
<br /> : _ Pro a Lime ^:�
<br /> .... . �::..... Diameter ' - ;. ..I -,ell ,.. p .,..-�.,.
<br /> / .R `::--..._' FOUndQtlOn '._ L�
<br /> 4 Distance to nearest: Well ' i Y
<br /> SEEPAGE PIT ; [ . . Depth: ._ Number :::.�.-- ,--=!___:: Rock Filled: •,Yes-Mr. --No•>
<br /> .. ,... W_ater,!Toble Depth . -- . Rock.Size ..f..,
<br /> 6 Distoncetto nearest Well �a_ !Foundation ° Pro Line_ z.
<br /> > j
<br /> i T{
<br /> REPAIR/ADDITION{Frau:SanitationPermit 96� ........ ...... ----------
<br /> Septic Tank (Specify Requirements) _.._.. - F ..'IV...............
<br /> { s osal Field .( pacify Requirements) s I � ilf� tl�� �,� ' �.�� /� ----------------
<br /> D;* _
<br /> Y
<br /> -----------------------
<br /> (Draw existing and^required addition on reverse side)` •[„
<br /> Thereby ,certify that i have prepared this application and that..the work 4illlibe-dono in'accbrdanc with San�TJoaquin
<br /> County Ordinanies,'Slate ,Laws;and Rules cnd 'RejVlations 'f the"`Sab'Joaquin otai HealWDisirict.'Iiome,owner or;licen-
<br /> sed.agents sigriafure.certtties the following
<br /> "1 certify that in the performance of the wdrk for W ich th s permit is issued, I shall not employ any is in such manner
<br /> as
<br /> to became 'subjec Workman's'Comp n at laws'of California."
<br /> i. Signed . • --• = Y ......... Owner
<br /> ..
<br /> i BY i:- . Title
<br /> {If er than owne � •_t
<br /> - iF R P MENT USE ONLY .• F ' .. ) ;I.
<br /> APP •
<br /> [ BUILDING
<br /> ON ACCEPTED 8�„l.i `'� DATE ...1. � �..�. _
<br /> LICATI PERMIT ISSUED ��---- °.
<br /> i t
<br /> i
<br /> ADDITIONAL COMMENT .... ....__ --•-• •. R
<br /> \ t A(
<br /> ..... ................ ....................... ......... •---•-•-----•-•---- 4 t_..._....•..... ..................................:......:..._..:......--•---'-•--
<br /> ....._....»........._.. ...--- ..5. .. ..... ----
<br /> _
<br /> Final inspection by: •-: f Date . . ] - _
<br /> SAN JOAO IN� LOCAL WEALTH RDISTRICT
<br /> .� . r a d _. _�w9�..n. �.k�F-:r. �M wW..nit.: '..�-�Iv.<-d-rw•C� n
<br /> ' r. w 13 241--s,Q v. Kix 7/7 .K
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