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FOR OFFICE USE:
<br />Permit No 7 7— -1'761
<br />Date Issued //- /- 77
<br />If•ks.
<br />
<br />FOleOFFICE USE:
<br />
<br />APPLIaaD7:FOR SANITATION PERMIT
<br />(Complete in Triplicate)
<br />
<br />
<br />Thii Permit Expires 1 Year From Date Issued
<br />
<br />Application is hereby made to the San. Joaqiiin Local Health District for a perrnit.to construct and install the work herein described. -
<br />This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:
<br />.., •••••.,,... ma* I : I
<br />i JOB ADDRESS/LOCATION.5 7 q. 3 .., 4, 1. 7 e.L /A. 4.we • CENSUS..TRACT : - _
<br /> Phone ie 35 —/$117
<br />Owner's Name.: ./4112.1.. ±..e.,A1.4-e•,../1/. 4.- 5.49",..5 ,
<br />I Address .52 4 3 1,$) Ve4 /4 ' 4 ci f :cit,; iie."?cy ea4• Zip . 9637 .4 ,
<br />4, Contractor's Name . 5 e Cc. .. ' 1,
<br />
<br />i : •• • — S
<br /> License
<br />InstallatiOn Will serve: ; . Residence 0 Apartment House0 .Commercial X Trailer Court 0 • ! . !. _ 4.... i. •_.:', . - •
<br />5,
<br />Lot Size 50 A cdzes • i
<br />Water Supply: Public System and name '
<br />Character of soil to a depth of 3 feet: Sand Silt Clay IN Peat 0 Sandy Loam D Cloy Loam 0
<br />Hardpan D Adobe El - Fill Material If yes, type
<br />••L. Motel j Other
<br />
<br />Number of living units- Number of bedrooms 0 Garbage Grinder
<br />_Private tgi
<br />(Plt clan, showing size of lot, location of system in relation to wells. buildings, etc. must be placed on reverse side.)
<br />NEW.NSTALLATION:- l(NO-Septic tank or Seepage -pit permitted if pUblic sewer is available within 200 feet,)
<br />PACKAGE TREATMENT [ I l'SEPTIC TANK [1:1 - '`•'• ' Size ' " Liquid Depth . 73" 0,
<br />' ...J
<br />, 1
<br />. i , .. 4......
<br />+ 'capacity. 11 =Type de_Material .ei_e.No. Compartments
<br />Distance.to,nearest: Well 360 --------------------/. .. .Foundation . /_e; i . Prop. Line /••01/ %V
<br />-00 daetiel eiwc,e a .-* ..•
<br />LEACHING LINE' [1.1, .No. of Lines .. •2. . . ,Length of each line 7,01 • .. Total Length ieoi
<br />, .0' Box./ ......Type Type FfIter Material ., Depth Filter Material '
<br />
<br />/ '
<br />e•
<br />.Dist9nce• to nearest: Well g.•1:0 Foundation la/
<br />SEEPAGE PIT [ ] . Depth ' ! / Diameter • k : NuMber
<br />• • ,..- •
<br />Rock Filled : Yes .ID
<br />
<br />, •
<br />. ..-
<br />. Rock Size
<br />" :Foundation • Prop. Line
<br />:
<br />------,./ / "
<br />, , (Draw existing and requi.red addition on re
<br />.verse side) . i I r .
<br />I hereby certify that 1 have prepared this application ciad:that the work will be done /in accordance with San Joaquin. County ,
<br />Ordittiinces,; State Laws, and .Rules and Regulations of, the. San loaquin Lo'cal Health District. Home cgvner or licensed agents ,
<br />q • !V ,•_, IP
<br />signature certifies the following: / / . ' I ' ' / i I.
<br />• P . • • •
<br />' . Jr.„---:-.,_....., • . I • '
<br />"I certify that in the performance of the workifor which tins, *mit' is ,issued, I shall not ;employ any person in such manner as
<br />to become subject to Workman s Compen ation .laws.".e-- Ortalifernig:"..._ F.
<br />,
<br />...,---.4.3.-... • - ) !
<br />Signed i ..f.. ...... ....g ; (.151.8i,,
<br />/
<br />By i . I 1
<br />:
<br />, . • i ,c C. -.1 I -i, i , • v .
<br /> I. 1 I (If other' thbn owner)
<br />' lr ITitle
<br />iq, 7-z---Ja ' I
<br />
<br />i 1: ' , 1 c'.4' '-----___I
<br />1.........
<br />413
<br />PARTME - T 'USE ONLY
<br />APPLICATION ACCEPTED .BY:
<br />DIVISION OF LAND NUMBER
<br />•
<br />ADDITPNAL COMMENTS
<br />Property Line 4‘0 1 •
<br />1 1
<br />,
<br />' Water TO'ble .Deptiii-":-....-- •
<br />,.. 4.1 ,
<br />-...
<br />f 1/7 . , -Distance:to nearest: Well
<br />REPA1R7ADDITION (Frew' Sanitcititfr;iPerniif # 1 '4 • Date
<br />Septicl'ank (Specify Req6irements) / / / 1 - 77------,--_,L i . /
<br />:
<br />4. 1 / Disposal Field (Specify Requitem Rt / . I
<br />a/ • / I / 1
<br />i i
<br />-
<br />i
<br />-t
<br />•
<br />DATE •
<br />DATE.
<br />,
<br />Final I rrspection
<br />EH 13 24
<br /> afran.
<br />j •
<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />•
<br />Fb.$ 21677 REV. 7/76 311
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