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FOR OFFICE UJ5E. APPLICATION ICOR SANITATION PERMIT <br /> „ Permit Na.;_�X.`:X --'-7 <br /> ..............•------------------- (Complete in Triplicate) ' <br /> I <br /> ........................... Date Issued ry <br /> This Permit Expires 1 Year From Data Issued <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 Ordlnante No. 549an/d existing Rules and Regulations: <br /> �l9.L. ..I..,_.._CENSUS TRACT ._A. . ' <br /> J08 ADDRESS/LOCATION ..zr_.���—.--.-�> �--._bpQ��.---- -..� . _ QQ <br /> ff�� �+ Phone ... �W_ 0 <br /> Owner's Name A------ ---s�'T 11�.� =` s- �• <br /> b ------- City _• 4?� ..... --...• -- .........•-••- <br /> Address ..__......_ .... ---------- ---_ --- - ' <br /> � VIW#*_l�I.... ._-Dl�vl_�_-6 D4 ------,�- O ��.License # .�3�i�. ---- Phone ..�._. 4.- -- <br /> Contractor's 'ame _... ,+J -- . <br /> !1/f6/l14lJLip�, SCR p <br /> Installation will serve: I es+ once LJJ Apdrtment Hou§e[� Commercial Trailer Court '� L <br /> Molbedrooms <br /> ❑Other. ... I 1 <br /> Numer of livingunits_f- -QNB Number ._____-__..•Garbage Grinder .!Y_ ?-•- Lot Size --�CR!✓Pr.� -- --•••• <br /> (' <br /> WC Supply: Public System and name - --- ------ --- • ---------------------------- -----------------------------------PrIvate <br /> t�r ___..._�- <br /> peat❑ Sand loam 0Clay Loam 64 <br /> Char der of soil to a depth of 3 feet: Sand�] Silt❑ ]y��, y <br /> "C1ay <br /> 14 <br /> n f <br /> Hardpan ❑ Aclobe-Fill 8ter+ I -c.Vl]-.__if yes,type..........._..----------- -- i <br /> of system in relation to•wells, building; etc- must be placed on reverse side.} `1 <br /> ji <br /> plan, showing size a# lot, location y NEINSTALLATION: (No septic tank or seepage pit permitted if pudic sewer is avaii �'wi-t�hi�n 2D0 feet,) <br /> SEPTIC TANK_ _ / Size_. _ .. .�1_x-_•� Liquici`I3epth _._ .. . ---- - --• <br /> PACT AGE-TREATMENT { ] Ur <br /> .�j <br /> ff7 -.... Type 1� r .13 Material---dal ! _ No. Compartments <br /> Capacity } <br /> stance to nearest: Weil --------SO.................- Foundation _..._1�..-----'..Prop. Line ._... . .....:........ <br /> .__ Total Length _ .- --•-- ' <br /> LEACHING LINE No. of Lines ._.____-�-------------- Length of each line..__.-ti?L�__--•--- 9 i 1 <br /> 4 Cl•---...__ . <br /> ' --- <br /> Box Type Type Filter Material ��.G�..-Depth Filter Material _•._.___. <br /> !47__.. Pro Line, . .f1�i.?.. -_---- . <br /> Distance to nearest: Well ........ <br /> �._-_-•- Foundation ---_--- ---- - •• rty <br /> ----.. Number .__ . ------ k e No <br /> SEEP, GE PIT [ Depth 1 -1 __ Diameter , <br /> c Filled Ye <br /> Rock Size __/ <br /> Water Table Depth --=---------��-----•--;-•--.....>........ / -- <br /> �-----._.. Foundation -- -� op. Line ..__I_._' --• <br /> - Distance to nearest: Well _...___ .._ .-�-r--Q--.-...- <br /> Date ----------- --------�..........I <br /> REPAIR/ADDif.1ONA.Prev. Sanitation Permit°# _------•------------ ....................../. ...... �� � <br /> v <br /> Se�tic Ta''nTt(Speufy Requir fnents) D ------------� �................ <br /> � - <br /> p <br /> mer5ts} ._ . _ 1 ...._. � ._....._.... <br /> Di osa Field 5 eci Re vire 77T .�......... .... ...... - ............... <br /> p fy q <br /> ---------•---•---•-- <br /> ........_._ :.... <br /> .. .---.---- •-- ----- ------•------. Y <br /> a <br /> _�- �— .-.:ter.- io on reverse side) <br /> ^� (Draw existing an required x <br /> have re aced this,a iso and that the work wi l be done a accordance wit So JoaquTM <br /> hereby certify hat �iP�P ��( , (4. r• `rt <br /> inan�es` tate aws,�andoles andeul�ntlans of the San Jeaqu n Local Hee th District. Home awnQr or lice <br /> County Ord , <br /> M: led agents signature certifies the following: <br /> + "1 certi that'infth performance of the work far whilh this permit Is issued, shall not Apley.any person i such manner <br /> i as to b ome sub's t ! o krnan's' mpensation laws of California. <br /> `` `` <br /> Signed - 1.1 ...._... <br /> ................... Title ------------- <br /> Owner <br /> I• (If of r than owner) <br /> FOR -DEPARTMENT USE ONLY <br /> �......'�v1/r1� -{�17?: DATE ...-l_...- -"• ' <br /> APPLICATION ACCEPTED BY '" '--1� -••--•---•� <br /> _DATE ..............----- - __ ----•----------- <br /> 1 . BUILDING PERMIT ISSUED ......... .. .....• . <br /> t -- -- --•------------ <br /> ADDITIONAL COMMENTS Qom- 1: .....}� ­­ <br /> J!w ...`.--;;---- •---------------•i - <br /> + ----------- - • ---- ---•-• •-•-•-. <br /> ... .................. �- . <br /> --------------- -------•-----...__._ <br /> ----•--- <br /> �..""""� <br /> e <br /> -----------=-- --- - --------- <br /> -..Date---- --- _'a=".:_ _ <br /> Final Inspe <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'66 Rev. 5M r1:�- <br />