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FOR OFFICE USE: APPLICATIOW FOR SANITATION PERMIT <br /> ��i .(Complete Permit N0.7-5�25._/� <br /> ... ...................** in Tripilia,le) <br /> ........................................ <br /> Dote lssued,a-716 ........ <br /> ......••-•-•:-••-.•••.--•-,--_--•---•t......•--••._.. . This Permit Expires I Year From Date Issued <br /> Application is hereby mode.to the Son Joaiquimtcicol Health District-for a permit to construct and install the Work herein <br /> 7 inance Nd�549 and existing Rules and Regulations: <br /> described. This application is-made,in with Cbunty-Oij <br /> 40 <br /> JOB ADDRESS/LOCATION T'�-liq�350�m..=,.,�.....M...Kin1dy-Ave � French CENSUS TRACT ......................... <br /> ..... ........ .......I.,........ <br /> I . - . -Cajilp,� <br /> -Owner*s Name ......Donald...F,-...Balip.back.:h 2� • <br /> ............................. ......... ---------- -- <br /> Address ..................1116 So Cre6ciint (St�reet` j LOdi <br /> ------- --- .......f....... ....... ....... ......_1..•............•............-..1•`..... ................. <br /> ...................­ "- <br /> - ---------- " ....m....... .............. <br /> ....... Phdi <br /> Contractor's Name .... j................. <br /> .......... .............. .............,License # ................. <br /> Installation will serve: Residence 0 Apartment Hou meklal MTroll*r Court C] <br /> . .;�Ll i i state licensed Guesthome for 30 Aatients <br /> Motel 0.0ther' .......... .__..................... <br /> Number a lying units:-.J 4�u, '*I . . 16.1 . 62-4 <br /> mbdr of becir ...........Garbkigo Grlr�er _49.,:f tat size A—. 3T6........................ <br /> AAJ� <br /> ...... ...... :.....Private <br /> (3 <br /> Water Supply: Public System and ........._t; ....................... . <br /> Character of sail to a depthid 3 feet: nd Silt Fla 4 ZPecW& . Sandy Loom ry 0ayLoom-0. <br /> Hardpan be PiliW <br /> I Ir yes,type......:*7-1. ............ <br /> (Plot plan, showing size oil lot, locati4n of�system,'In relation wwells,-' buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No"septic pit emitted 4fSuOlic sewer Is available within 200 feet,) <br /> .tono or-s000e.661 <br /> 1,0 1 ' " <br /> PACKAGE TREATMENT 11 ' SEPTIC NKf .......................... Liquid Depth .......... <br /> ** 0 <br /> .. ... .... <br /> t - 0, <br /> Ty ateriol__Y�V ... No. Compartments ......1W <br /> .....Founclation -3.11.............. Prop. Llne .j?.04............. <br /> Ditroncejo 666f st. ell ............... a <br /> _�.. I ' - 01 <br /> -Lines . ........ Long 00 ,..... .................. <br /> .......... Total Length .....4 <br /> LEACHING LINE No:�.af th' each fi�e <br /> `D' Box ..Cemer7jrpe Filter Material ..GraYE1. Depth Alter Material ......2�!=..............I................ V <br /> .1 qt�,, I <br /> Distance to neoreii 'P! .k ......... <br /> 1 200,.' <br /> st- Well ............. foundatioi; Property Line AO <br /> k No 0 <br /> 'Pr....7:� Yes-10' <br /> SffgGE PIT De�th .1--D-.. ._je!_ Dlorn r Number,7��_.7.4t Rock Filled <br /> 4 1 1'. 1 .,e �4 � ;.V f -4. - I r <br /> fttern-tTable-041h ...�..!?4j(Jd... 6��P- Rook size ..aAAW_1.............6, <br /> Z <br /> "V, of ' <br /> ci�Line ...1.t!........... <br /> Disionce to nearestt Well ............ ............. ...F6unclation .2.47?............PJ <br /> REPAIR)kODITION(Prey. Sohitation Permit# _�......._1. ............................. Dato ..................... --------:9.) <br /> iii <br /> ........................... <br /> Septic Tank (Specify Requirements) ...... ..... ...11....... .. .............. ............... <br /> .. . <br /> Disposal Feld (Specify Requirements) ---- h tines. Each 11 <br /> ............*........... ......;.he to_ ... ........ <br /> ............. <br /> �,pj_t---at--.'the...end...af..e-a ---t.ol ...4!....w1a't-..5.!. .3-0trig.............. .. <br /> ....tip-10-0-!---�1-0,119...With..a ---b-p- <br /> and ton f filled with grav-elt as r&�.Aiisted. <br /> ,eet deep <br /> ........................-........ ... .......................................................................... <br /> .......................I...... <br /> ......................... X— , (Draw existing and required addition on reversl,side) <br /> 0 r'fjis done In accordance with Son Joaquin <br /> I hereby certify th�.rl i64",liripared this application and that the work wil <br /> he <br /> County Ordinances, State Laws, and Rules cuid')Regulcition�ot <br /> f 'Son Joaquin L6C61 ko@fh,0Istdct. Home owner or licen- <br /> sed agents signature certlfle6 the following- <br /> I , I shall ritt 4"lno <br /> "I certify that in the perform plo� <br /> once of the work,for which this permit is issued, y cmIlr person In such manner <br /> as to b Wof main's <br /> pensation laws of California." <br /> ........ .............. Owner N-1 <br /> Z!, <br /> Signed <br /> . ......... -..---------------------......--•----•--................... .Title ... ................ ................................. ............. <br /> other <br /> If- <br /> than owner) <br /> By <br /> -- Fog DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... . .. ...... =577=17 <br /> DATE. ... ................................ ....................... _ -_ <br /> BUILDINGPERMIT ISSUED".............•--------•... .........................I.......................................DATE ....-.-................-.'::-..•....--....... <br /> ADDITIONAL COMMENTS .i ..........7�......................... . <br /> ....................-------------- ...... ................ .....................*............. ...... <br /> ............. <br /> ............................................. ........................................ ........... <br /> ............I................. - ----------- <br /> ............ ............................... ............. ...... <br /> ............................................. ......... r <br /> Final Inspection by; ......: I.................... ........... . <br /> .............. ................ <br /> ............... ..... <br /> ............................ . ................. 4 <br /> . .......... <br /> JOAQUIN LOCAL HEAKTH DISTRICT <br /> .... ...... <br /> EH 13 2h 1-68 R0.) 5H SAN 8/7h 3MI, <br />