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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT , <br /> ..................... ..........I.. ................ ... . F MN►Na �t`?. � <br /> (Complete In Triplicate). _ . ...__. .. . .. <br /> ..... ......................... // <br /> ............ This Permit Explrrn 7 Year From Deft Isswd Dote Issued A�A,.....�1� <br /> 6 Application is hereby made to!he San Joaquin Local Health District for a permit to constrict and Install the work Yaks <br /> 9 dewlbed.This application Is made in compliance wiih�ountyOdlgi7ns"0o. Sd9 and exi■-Ing Rules and Regulaatt(xus <br /> JOB A@DRESS,/LOCATI _L..9,5'J_7.. ... Ll.ke+(J .i:-s(..f^zarB V &ii.,.............CEll)" TRACT ...... <br /> Owner's Name ... ... . ... Gu�Lel1%.........................................................................Phone .J-.. .1. ..7 .. <br /> ,y.: <br /> Address ... ._............................. .........7�v..7.a�.... lt,or.�:if.. 7 City..._......j7"----..........-----.........._....-..__...._. <br /> Contractor's Name.. ?!i4.........:............................................._...........License# ........-............. Phoft ........................._. <br /> Installation will serve Residents❑Apartment House Commerdalrail�F% 0 <br /> Motel Q Other...-......_............................. .rr-�.ffuu <br /> Number of lMng units a <br /> ?..:..- Number of bedrons ..3..__.Garboga Grinder Lot Size <br /> Water Su Pubic i stun and name . .Qias.e,�_..EGl:C�.....F>° a,R0.....sr�...r�.wtA.i•J'Jl.w-..^..-..-....Pri`^Mt, . <br /> PPIy� r Y <br /> Character of soil to a depth of 3 feet: Sand O Slit[] Cloy Q Peat 0 Sandy loom fif Clati Loom G <br /> Hardpan❑ Adobe❑ Fill Material............If yes,type_......................... <br /> (Plot p.San, showing size of tot, location of xystem in relatlon to wells, buildings,.*;o. r:euv be placed ata reverse efde.t <br /> NEW INSTALLATIONS iNo septic tank or seepage pit pem:ltfe6 If public sewer is ava9,jble within 2M,?eet,1 <br /> PACKAGE TREATMENT f I SEPTIC TANK Vd Sise..�}�.�'tr..�:.�:'�:.�.a.................. Ucluld Deptt! ..�_`^:�:.........._. b. <br /> Capacity<!AC°....... T .... rOt.`»�.', Matadal.4M:?:.......... No, Comportmerts <br /> Distance to nearest. Wall. .... 'Q....:�:..................Foundallon.e.0....:!`'..........Prop.Lina_.. .:'f.:.... _.. <br /> LFACHINGLiNC No. of Lines ...1.................. Length of wdt line....e ?................ Total Length ...zslt?............... <br /> ° •D• Box . .. Type Filter Matericl , .. ...Depth Filter Materiel .................... <br /> . - Distance to newest, Well -0............... Foundation _/.0................ Jroperty Line Q".':............_..- � <br /> ................ Diwrsber ............................ P.oski j <br /> Y.w-sad..D.Pib ..: ...............................R-,yam,.,..._............ <br /> DismorsAs�+erstessr'Y9ltt................................_...Fwsovkokm -::............... Prop. Line .............. <br /> ...... <br /> 91?AIA/ADUMON iPrev. SoniTatior Permit#............................................ Date .... ..._. .............•...1•.. <br /> .Septic Tank (Specify R"vir.rsentsl ........................................................ ..............._.._......_.... <br /> Disposal Field (Specify Requirements) ------"----------- ---• <br /> ..........................._...................................................................................._............................................................................_.......... <br /> ---'...................._._........._-...................:............ .......................... ................................................................................................ <br /> (Draw existing and required addition on rworsn sldo) <br /> I hereby certify that I :naw prepored this application and that she work will tw done in asxstdanee with Suss joagvlis <br /> Ceuny Ordinances, Sim* Laws, and Rules and linutationt of the San aoatiula Laical Hoa tb 0111det. Hcme st"er Aw vewo <br /> sed ageets siSnatura certifies thw followings <br /> "I csrtify that in the performance of the we..k for which this permit Is Issued, 1 shall net employ any Person in sods ma.'ww <br /> asto bacp a sublect mo ' Compensation Lawn. of Californlis" <br /> Signed � .Y .. . ..... ....`..:Vis...... ........Owner ._... . <br /> By - ... .... ... .. . . .. ... ................ . . . Title . ... <br /> jlf other than owner) <br /> FOR DEPARTMENT USE ONLY . <br /> APPLICATIONACCcPTED BY. „�C . ..f�Yf.r..I�RGP.''... ................_....... ... ......._.... ...........DATE./P_S.ry ? .. ...... <br /> BUILDING PERMiT ISSUED .. ..... ... / ......... ....... .... .DATE ...... .. <br /> ADDITIONAL OMMENis . , G* :,lLb:ei s:�,�ctsaUarel O ....,.�f r1G"� . �.✓BJ.- - ' <br /> 'fir .. <br /> - ..fS�:.aa'ifa Lfr✓1+o/4 Sv(aw�j...bZ, p,+L..tcw�Gt --!« er.ouarG.� .a+r.-C .trr.�r:wrP.�Q_ . .. <br /> !G ..!'Tt2fPc a`;*•rr,.f.. �N L. rJ. H.�iler�ittG� jif fs......(-/..�-...f/ �/. .�,-...:.1:./•a.e. r <br /> %.I`............. ............. <br /> ...Dote... . 7 ... <br /> y�J Jf .. . �J,/ 1 <br /> Tirol Inspectio by .. .�/../! .a .. ... ....._ .. ........... ... .. .. i <br /> M 13 24 1-6q Rev ff�� SAN JOAQUtN LOCAL HEALTH DISTRICT 6/7h 3M <br />