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1 y <br /> MOM <br /> r-r: � E� .•4.. ,II��F� `.':*ti:N6-.w +�.� a .r.A sem' s� � <br /> FOR OFFICE USE: - � } <br /> APPLICATION FOR SANITATION PERMIT _ ,4 <br /> Permit No <br /> iComplete in Triplicate) <br /> Dohs Issued ' <br /> ......... .................. This Permit Expires 1 Year From Date issued <br /> Z. <br /> K �« <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install <br /> the <br /> `worlc`,henIn: <br /> described This application is made in compliance with County <br /> S7./ IS� Ordin ce No. 549 an. <br /> d existing <br /> g R„urlesp and R.e� <br /> gurlaStions <br /> r <br /> USTl �l9.VJ .- CENOBADDRE5 / _ a�en_.. __•_- <br /> t; : !• -- - <br /> .............Cty/.�� /.r--- .... �v Y ,� <br /> r <br /> Confra�cfo�s Mame .�:.-r�....��..._.. .fi..'�......:.............................License����/�_. Phone--F:1'1"6�,� '•�ri <br /> r <br /> tallatio„wtll serve Residence❑Apartment House]C mercial QTroiler Court �] <br /> Mtel Q Other 7'' Y_.._.. h •, <br /> r <br /> - K - y <br /> .Num r of Irving,units... ...:.... Number of bedrooms ............Garbage Grinder .. Lot Size <br /> Water Supply: Public System and name .....-••••••-••-•-•.................................... :........ <br /> Privy <br /> Character of snit to a depth of 3 feet: qnd}W Silt❑ Clay.❑ ' Peat Q Sandy Loam 0Clay,Loam❑ <br /> Hardpan❑ Adobe (] :Fill Material If yaa;type_.... : <br /> {plot•plcn, shawIng size of lot, location of system in relation to wells, buiidtngs e!e must.be placed ort reverse ifde) <br /> NEW INSTALLATION {Na septic tank or seepage pit permitted if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT <br /> {7 SEPTIC TANK Sfze :...� XI 4 Llqutd <br /> D006" <br /> l - D006"'4'- No Compartmentpacy •- •-_-.. Type Materia <br /> Distance to Od <br /> t <br /> nearest: Well ._._�....... Foundation C Prop.Lire ' <br /> s' <br /> Length of each iine . <br /> L1±ACHING LINE-'° [ ] No of Lines Tota! n h SJR <br /> .'D.Bax`.•--..-.... T Filter Material.� .Depth Filter'Material O <br /> r ' ` <br /> Type w F <br /> Well .......................... Foundat <br /> Distance to nearest: ion Froperty:Line, ♦... <br /> Lt <br /> Filled ea <br /> E,PIT [ j �* Depth ..................... Diameter '... Number ................ Rock FiY z[3 No lCJ <br /> _..__ <br /> +mss aFf <br /> ,Water Table Depth _. ._ ock Size ' ' <br /> R <br /> to nearest.Well ___...Foundation Prop rLfne <br /> o <br /> {tEPAiR/ADDITION(fir ,Sanitation Permit ..... ..............:.... -- -- -- <br /> Date <br /> ' `St�TicaTank-{Specify Requirements) ......................... <br /> Disposal 7 Fieid" S R uirements] � ' <br /> ds. <br /> I pe+fY �I ; <br /> _- <br /> (Draw existing and required addition on reverse side) <br /> I hereby,certtfr�fhat Thaw pripareii this'application and that the-work !t be Boni in aeeordarcrwith San�Joaeleltt <br /> County Ordinances,State'Laws;'and Rules and Regulations of the San Joaquin Leval Flealth DisMd Herne ewnsr ee Itanr <br /> sed agents si*nalun csrtiFies ti;e following : n r` { ' ''� ` <br /> "l certify„that in the pe.forniance of the work for which this permit is issued, I shall net ee.ploy arty person in'such manner <br /> ai to beeeme subject to Workman's Compensation Iaws of California:' , # ' <br /> Ne <br /> ,. <br /> ' ............' Rc .._ ...... ...OwnerSignod <br /> YTitle.... <br /> F»,, (if other than own r) ;' �i; i,` atk'�aar►a.. d; 1, . FOR DEPARTMENT USE ONLY 44, <br /> r � <br /> APPUCATION'ACCEPTED BY ..0--D........ ... .. DATE” I .7 " �y <br /> + N"--:'BUiLDING"PERMIT ISSUED ........................... •-•---•-•--••._.---• DATE <br /> ADDITIONAL COMMENTS <br /> .. <br /> ............. <br /> i <br /> t . - <br /> '� .__ ...... _........................ ......... <br /> •- _ .... .... ... AA _g <br /> ._ <br /> { •-__—____ __— w / _._.-..... . ..................... <br /> ¢ <br /> ..... <br /> I............ ..........• <br /> o ....................Final InlpectDate �A . <br /> ^. <br /> t ' <br /> * * 5AN !OADUIN L-HEALTH DISTRICT <br /> LOCA <br /> sY <br /> E.H 9 1-`68 Rev.SMo <br /> V <br /> ,, C''F{:''.a �, _ .�. _ t- . �..,r. ..*i:4'��*. �ti ,i<:�r9a�'BF� �s?�:, i-sy•�•?'. `i.-�!�.,..-.�`� �1�.-e��� <br />