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9�f�kr' r4rY•`.�'"x !+M^wx: y .K44; ! ?.,fry rrY..!•�n`1.-�/ ; rr s,• "� - OPT <br /> S l'r a 1 <br /> F F ILE <br /> FOR O>Ftt'E USPS APPLICATION FOR SANITATION PEWIT <br /> } ,- Permit No-Z- <br /> �:. ............ <br /> ..................1111.................. (Complete M Trtpikatef <br /> F,a r Daft Issued. . This Pemlf Expires 1 Year From pout Iseved <br /> .* " .."Application is hereby made to the San Joaquin Lacat Health Distrkt for a permit to condfrsrd and Install the wait ice' <br /> , described.this application is made in compliance with County Ordinance No. 549 and existing Rules and Rogulalbrt$r <br /> rs ? <br /> ".JOB ADDRESSAOC ION .....���� /�C... � ......... ...11.....................C� TRAGI �6ZG/ <br /> .. _._...1.1/ Pltona S'Y.�'......._.«1111.._.. <br /> owner's Namc/- .............. ....... .............. <br /> Address9 ... .../7 � r�Q`. ..................................Cityx.................._..._.............._.. _«._....- <br /> 'a rri ...license f........................ Phone 'Z <br /> ;.,. Contractr+r's Name . <br /> 'M` pa fl Commercial raiser Court f7 <br /> Installation will serve: Residence A rtrraerN Flaua Com [�T - .. <br /> Motel❑Other.................................... 1111 <br /> a u Number of living units.. ...�... Number of bedrooms . Grinder •...... . Lot Stu ......_.... .»..--• <br /> WaterSupplyt Public System and name..............................«.1 -.-.-----.-..------ ......._..........._........,.«. ..Plrlvnle� �. <br /> s r.. peat❑ Sandy Loans 0 Cby.Loan►EV <br /> +? r Cltaracte► <br /> of <br /> to a depth of 3 feats Sand❑ Silt❑ Clay Q <br /> Hardpan Q Adobe Q Fill Matwlal 111 1......if y",fype................. <br /> Y <br /> (Plot plan, showing size of lot, location of system In rebtlan to wells. buildings. etc. MUO ba Placed ess loveisi :idol <br /> NEW RISTALLATIONt (No septic tank or seepage pit permitted 5f public sewer Is avaib vvHhtn 200 faeP,) <br /> s <br /> .' - PACKAGE.TREATMENT [ ] SEPTIC TANK( ) Size......_« ................. <br /> .. <br /> Capacity....:. . ......... Typo .................... .................. No. Cotnparfntenls .. _-----•' �.- <br /> .. <br /> Distance to nearestt Well .....-._............... �...... Prop.L1tto ... <br /> s LEACHING LINE [ ) No. of lines ........................ Length of (lrte........_.... ........__._. <br /> � Total <br /> b' Box ............ Type Pilfer Material Depth Material ............:.« -Y�• <br /> Distance to nearest: Well ............... ... Foundation operfy -•»Y�rw,�-, <br /> Number Rods Filled Yes Q <br /> e ? SEEPA(A- PIT [ ) Depth Diameter .. .._..-- •......................... s � r <br /> 4h Water Table Dopth ........._....:. _._1111_. Size........................... <br /> F ; r DEstcnce to nearest:Well 1111. _1111 ..Foundation - « Prop.'LiM <br /> "?tl` R6A1R//1DDIT10h(Prey. Sanitation Pormit#......« «.................../... Date ------- - <br /> w,�Fti. Tank {specify Rsquiromentsl _..................._. ........»1111«........: .:.. -r � <br /> y it! ....««lam«' 0 lY~u .f'��� <br /> ., x Disposal, Feld {Spe.-ifZ• Requirements) <br /> .. <br /> { ; �fF !7..La19....... .....�f.:'-Y..�.].........- 7.1.4...................... <br /> ! Z4 ....................................... ._............-._11..... ...«...._ -_. x.�� �• `,�_ <br /> {Daw existing and required add(LSon on reverse side) • <br /> torsi that I have prepared this application and that the Werk WM bedeity M'ustardtritee VAS few <br /> 1 hi+ral»► <br /> s � s.Coun ' Ordinancoi, State taws, rrt$ Rules and Regulations of the San Joaquin <br /> Local Nealt11t.DlsMet.N6040 naewr.or Nam <br /> ' •�`N:std awti signature certifies the following: � <br /> ��.-"i cartifr that in the performance of the wak for which this permit Is Issvod, 1 $1101111 "Of ensplep MW person ire trd!twettttM <br /> �,; ", as to became sublets to Wer an's Compensation laws of California:' <br /> c` ned <br /> r ...... Owner <br /> ' �g I <br /> By .:. ? f•.�••�.• .......lite..._..........:.................. .r.� <br /> other an owner) <br /> �E7 s FOR DEPARTMENT USS ONLY <br /> '-APPLICATION ACCEPTED $Y.. ....-t 'C........:. ... . <br /> 1 <br /> 1111 DATE �.. /:.. ..,�,_..: <br /> DATE .......... <br /> f 1111... <br /> f BUILDING PERMIT. ISSUED ••• <br /> ii --••----1111.........................� ..................................._.......... <br /> ADDITIONAL COMMENTS 4.......................... <br /> 1111............. ................_.................«._.......... <br /> . ..................._.................---......_...... ._......................................_................:..... .... .................... <br /> ..... <br /> ....�,.. � 1111... <br /> +" Final Inspection by: ,�...... .. ... G.2 ........................ ,.. <br /> z EH 13 2h 1-68 liev. SAN JOAQ IN L L HEALTH DISTRICT 8/74 31'1 <br />