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r <br /> I USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Perpit No.. <br /> ............................................. ....... (Complete in Triplicate) <br /> DoeIssued ---------7P <br /> .............................................. <br /> This Permit Expires I Year from Date issued <br /> . .. ............... <br /> ............ -*. ......... ........r........ <br /> and Regulations- <br /> Local Health District for a permit to construct and in tall the work herein <br /> -by made to thWSan Joaquin ' 549 and existing Rule <br /> Application is here nce with County ordinance NO. <br /> described. This--g' pitcation is made in compliance <br /> LZT 2- oor.....JZQ. ESI: '..-CENSUS T�ACT <br /> ... <br /> JOB ADDRESS/LOCATION •L .......... ........Phone I....................... ..... <br /> m K <br /> -�-111 (__F�------------------ <br /> LIU----- <br /> ---- -_ --- ------------------ --------5A --------- <br /> Owner's Name -------1­-F_,D r — <br /> ...... .... <br /> Address ------------V3-0........... ..S-.._.----•-i1 ••---••---...------•-•-•--•-•--....._.-•7 ........... city .. I ......................... <br /> • <br /> Contractor's Name -------------------- ...........................................License# -------- ---------------- <br /> a—d <br /> I Residence❑C]Apartment House 0 Commercial 0Traile&A <br /> Installation will serve- =t' <br /> Motel E]Other ----- -------------------------------------- <br /> .I t, rider Wa..... Lot Size ---Acf-3 FE ---------- <br /> 1! drooms ----/.....Garbage Gri <br /> .1 Number of <br /> Number of living units:..-')7i ........Private M� <br /> ................................. I <br /> Water Supply: Public System and name ---------------- --------------------------------------C] Sandy Loam 0--l"Claly Loam [I <br /> Character of soil to a depth of 3 feet: Sand 0 <br /> Silt C1 Clay 0 Peat <br /> r-A�_""Kl Adobe 1[] Fill Material &_ If yes,type........... .......... <br /> ordpohU <br /> t be plated on reverse side.) <br /> location of system in relation to wells, buildings, etc. mus I <br /> (plot plan, showing size of lot, t permitted if public sewer is available within 200 feetl i4 <br /> (No septic tank or seepa e Pi p 6 ? <br /> NEW INSTALLATION- I *XXI Ili id Depth <br /> ......... qui <br /> Size <br /> SEPTIC TANK' <br /> PACKAGE TREATMENT <br /> T ornpaAMents <br /> .f��RB <br /> TypepRM-07 <br /> Capacity ------- ........ Line <br /> Fauncicition .rr 1-1p....- PAb� <br /> p <br /> ............ <br /> Distance to nearest- well _,570------------- <br /> .11 N I 'I Length ....... <br /> h f each line_..E ... .......­ Tota 9 <br /> LEACHING LINE _�No. of Lines -------- t 0 1 <br /> ------- ............. <br /> Len <br /> pthAilter�Materl Ij.......all 17r Material QC-K..Del__........................ <br /> V Boxy -- Type Filter Pipperty-line _..-----•---•--•------- <br /> VO <br /> t.........7 <br /> �e to nearest.. Well ...... 50 <br /> ---- ..\Foundatiol" <br /> Distance er Fiji' Yes 0 NO 0 <br /> I Numb ----------------- <br /> I r_!_ Rock ed' <br /> 'tb Diameter ........... <br /> Dep ........... <br /> _.w� --- .......... <br /> SEEPAGE PIT-, I I I R 4.La i <br /> Water Table Depth ---- ------------------- ------------- p. Line .........------------ <br /> 01 Rdbtiorr­.:-77�7�., Pro <br /> ......Foun <br /> DiAncle to nearest: Well ---------- ------------ �-,[ 1-1 <br /> I :7i.ln Date -------------- I <br /> REPAIR/ADDITION(Prev, Sanitation Permit# ---------------------- ............... . <br /> ........I _rJ9 <br /> Requirements} --------------- ----------------- <br /> Septic Tank (Specify Requir 4 ...... <br /> Disposal Field (Specify Requirements) .------ 40 IP-§ ----- -R� : <br /> I i-----_-A....................... <br /> ...........­ ­-)-------- ----------------------- <br /> .......... IR-19--------------------- <br /> IJ " I ----—---------- <br /> ......FARM_. ....... ....I. ...... <br /> ----------------------- ............................................. --ci aciditiln..on-reverse side) <br /> ........ ..... (Draw existing and requ0e I t Joaquin <br /> V -.i no-in accordance with Son Joaq <br /> repaired this application and 'that the %Vork will 69 do <br /> I hereby certify that I have p 6 :4 Joaquin Local Health District. Home owner or licen- , <br /> and Regulations of the Sch <br /> County Ordinances, State Laws, and Rules <br /> sod agents signature certifies the following- Terson in such manner <br /> "I certify that 1P the performa.6ce of the work for which this"'Armit is'lPipecl,'!11.1hiiiii not employ any P i <br /> n laws of 60'hfornia..'! <br /> k 05 C-0-r"peXnso <br /> as to become Ubi oftit too VfOr ran <br /> -------- 04ner <br /> ------------ ------- <br /> Signed ------ A ........... <br /> ......... J ........... ................... ....... <br /> By -------------------------- ------------------------------------------------------------ I <br /> Jif other than owner} <br /> FOR DEPARTMENT US!' ONLY <br /> DATE - <br /> APPLICATION ACCEPTED BY' .---------------•----....... <br /> L� -----_-------------------- <br /> BUILDING-P-F"IT-ISSUED-.- ------------------_---------- <br /> - t.F' 7... ....... .. <br /> ..................... <br /> ................ <br /> D V! <br /> 4,5 <br /> ADDITIONAL COMMENTS i4 XR-"_ <br /> .......... <br /> ..... <br /> ------- -------- <br /> ------------- <br /> ......................... <br /> ................. <br /> .......................................... ­--- ---------- <br /> ......................... ..-•--••------. ..Date -------------------------- <br /> Final Inspection by: .------- --- ........... - T' zt)/ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.9* 1-'68 Rev406 <br />