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FOR OFFICE USE:
<br /> APPLICATION WR SANITATION PERMIT
<br /> ...............•........_.....__.__.-----...-----••--•• - h Permit Nd, 2
<br /> .�............3
<br /> _.�.. ,„. {Complete in Triplicatel " ,.. .9 •„< .
<br /> .. 3 . .-`-.... i ..._•. ...... 1—-this� Phis armitGpires-1 Year Prom DaW”lsstisd' ! Date'Issued
<br /> A00heation1s he'reki made to the Sant • s
<br /> Y :loaquin,loca) Health District:for a. permit to construct and Instal! the work herein
<br /> described'This appl€ dtion:is Made,in compliance.with`CountykOrdinance No.'549 and existing Rules and Regulations. I f
<br /> JOB ADDRESS LOCATION ...- . _ -
<br /> ► ; . . } .. CENSUS TRACT ". '
<br /> Owner's,.Name,....-.. `' � 1 € ;:
<br /> tt
<br /> ...............
<br /> Address .................I . ��G.... • i .. . Ci s __
<br /> i ,.r..r -- '
<br /> Contractor's Name_`---�' + License fi� � �Y Phone .
<br /> Lt -., ,.xa.r,.-.+7•, K.W. n-..^s*-„�r•m.w..�,.,.,. :-I/'-�..�=- --<>.� _ ;. -:.a- -••-- ---7- l ---5.- - -------------
<br /> Instalfation will serve: k +
<br /> z t Residence Apartriient House 0 Commerclol❑Trailer Court '
<br /> i F a Motel ❑Other i-- . w r
<br /> of livOnf t �. g_ K t.- Ir
<br /> J. / I
<br /> Nur�tber units. .......r Number`of '64ddi'o"s �
<br /> 9 - s � Garbage Gr€nder Lot Size _le"”'
<br /> Water,Supply:rPub is System-dhd nbme' y - - -----------
<br /> .$ .` - .. t '... . . . ,; . 'i _I_ i
<br /> P r _ .
<br /> _ Private ❑1
<br /> Character of soil to"a de th of 3{feet • Sand❑°�" 5€It(3� y 0 ` y _.. .
<br /> 4 i p Cla` Peat' Sandy`Loam ❑ 4'Cla Loam (\I
<br /> . { {Hardpan"1:7,. Adobe Q Fill Materiai'. tf yes,type:... F
<br /> {Plot plan, showing.size oft lot,'locationk of;system-tin relation to welis,t buildings, etc. must" be plated on reverse side.}
<br /> NEW INSTALLATION:" i
<br /> iNo septic tirnkor seepage pit Aermltter! "if public sewer s available w" ithin 200 fee
<br /> t,l
<br /> •
<br /> . 1 k -
<br /> , ..........Si :._ Liqu'id D!epthEACKAGE TREATMENT, [ I " SEPTIC-TANK[ 4 4 ' , .. t6
<br /> .............
<br /> mprments 4apaelty Material. No.--- TYPe
<br /> Distance.. to h nearest: .Well " ._. i .. ° ....__Foundation . ... Prop: Line
<br /> :_
<br /> LEACHING,LiNt [ ] ;No: of Lines ... I _ _-i-. Length::of,each'If ................
<br /> Taal "Length '
<br /> .. �.- ., ..........
<br /> " r 9 'D',Box s Type Filter Material . :Depth -Filter Material _, __ _•_ ...
<br /> + t Distance to nearest Well dation
<br /> roperty Llne
<br /> S EPA�GE P!T [ l Depth t --
<br /> .j Dieter 4 Number - --_...t....._:. ' Rock Filled Yes ❑ No ❑
<br /> �. -Water Table Def t}r 1 r .. _ ..
<br /> !� ._ ._Rock Size -•-••------
<br /> '
<br /> L I ' � __ ....................................- v
<br /> ........... c '. s ................
<br /> Distance'to"nearesWell `
<br /> -_. ..... oundat€on Prp Llna
<br /> RE'A!R/ADDITIONlPrev. Sanitation iermlt # � —� •Date{--
<br /> .
<br /> I
<br /> Se tic Tank S eci 'Requirements) L i .. I........_. a E"'_, i••" �..
<br /> p i p fY 9 - •----- -
<br /> DisposaL Field. (Specify
<br /> .......... `�..E. i
<br /> i l I _ {Draw existing and"required addit€on on reverse s€del __.
<br /> I herebk ; ihave
<br /> t ° # r s
<br /> y y �certify that 1•have,prepared this appllcatlott and'that the'wark wilt be done'in accordance'with San}loaquln
<br /> Coup ' , ,:. s owing: t 9 �n Joa ulrr Lpcat�Hea - + t
<br /> ty �rd€nances,:State Laws, and Rules and Re v[afions of th® Sa' v q llh;bistrtct, iHort,e owner �sr Ikon-
<br /> he,foil
<br /> sed etifntthat in the_:, "signature Performa ce of the work for_Which thii peftivislksued vshfarnot er'n" is I I
<br /> i gw.. .,- . bk._. w x r , p Y any person in such manner
<br /> 1. .,•: -l 1---..-•-- --- P - - � Owren
<br /> as to become sub ect to Workman s Corn ensatron laws of Califo;nln, , t
<br /> � r k „ 4
<br /> i . r 1 , i t k r
<br /> Signed _... }}
<br /> i
<br /> ._---_.___ k
<br /> By ------ le ;1__t)4 +
<br /> - ------------ ---- -
<br /> t If other t r � , h �.i.
<br /> I than ownerl , ti Frit {, +
<br /> R"• IEPARTMENT,USE ONLY 3 a .•.,t.. I., } '
<br /> APPLICATION ACCEPTED.BY, � ._i � _.._. _.:: .-:_ _ DATE s5
<br /> BUILDING PERMIT ISSUED ---- --------------------------
<br /> ------------------- ;E
<br /> ...........•_---•---" •--:... -------------DATE .......................................... E
<br /> ADDITIONAL COMMENTS .................. ---------•---...__..
<br /> -----------------•------
<br /> -
<br /> ------------------------------------------1....... ......_ ................................................ ---••----------------------"----
<br /> -------------------------------
<br /> -•--------------- �^ t
<br /> Final Inspection by- ------------------ -_ Date ... ..""
<br /> ..... ..............--••-•--------......_.......-. -_.-:... et.... a
<br /> Eli 13 .24 1-68 ib-,v. 5m `
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M
<br /> k
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