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- <br /> FOR OFFICE SE.� <br /> Ac- ^� , APPLICATION FOR SANITATION PERMIT <br /> ------------ <br /> 'k . (Complefe-in Triplicate) <br /> -------------------------- <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local neonn u/m,/o for apermit to construct and install ... __. .~_. <br /> described. This application is made |n com,�kance with County Ordinance No. 549 and existing Rules and Reov <br /> ����r�� -----'---' <br /> JOB ADDRESS/LOCATION x^r,^^^_°~~_----��-----_- <br /> CENSUS TRACT . <br /> . �n�no ;r'�^���^�^, °^--''- <br /> Owner's Nome ,�6M���'°z/��.u�ar�����_-----.---_.----'-----^'------� <br /> AJ6neo, __ IrAPI-------- city <br /> -Ar.&�7i-----------_ <br /> ------.----'-. <br /> Controdo4Nome ------- = -----------------------------------------------------------------L|cwnya #1775Te-_5... Phmme <br /> ------_.--'' <br /> |nstaUation will serve. Reslderce4NApartmem Housef-I Commercial [ITraU6r Court � <br /> No»oi F-1 Other --------------------------------------------- <br /> Number <br /> ----'_—__---'- <br /> Nwmber of living units:-/-------- Number of bedrooms '59------Go,6ogo Grinder A-10--_ Lot Size °w'.,� <br /> ( y -/------------ <br /> Water <br /> -.--Voto, 3�upp|y. Public System and nome ------------------------------------ ------------------------------------- ----------------------------------- <br /> , <br /> Private <br /> . <br /> Character of soil to o depth of feet: Sand'E-] SiltF-1Clay E] Peat El Sandy Loom El Clay-Loam El <br /> Hardpan Adobe 0 Fill Material ----- ------ If yes, type ---------- <br /> . `P_ ,_, --'-~ size of lot, location of system <br /> � NEW ; (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ��PT|[TANK -Size ���^, Uqv|6 Dmo�� ���---------------_-- <br /> Capacity <br /> --,'_ <br /> PACKAGE TREATMENT [ ] -`' � ^ � ..;z.«_�.-�' --------' ' ' ---' -_ <br /> ----------'� W\w�e ko No �nmp��m�n�n �� ` <br /> | [opuci�y �°6%�?���� Type _. r /��,�^�»*^�_ ^ ..^_ <br /> / --------- <br /> Distance ,o nearest: VVeU ---. 4�7�.-------Foundation -/~��.,--.- Prop. Line .<��--,_.-_ <br /> � --------- <br /> LEACHING LINE �� No. of Linea --�-----.. Length of each line-- _//�f!.,.---' T��o| Length --la-0'�.- <br /> | Depth Filter Material �4�"' <br /> � '�' Qoxx��--. Type Filter Material ����t�-.-' .,-_------_--,.._--- <br /> | ° Diutonce1u nearest. Well -�[70.----' Foundation _./�1.r---- Property �ne���----.'-- <br /> Deo�� �?*�/ Diameter �^� ^' Number / Rock FA|n6 ��y�� No �] <br /> SEEPAGE PIT 6�' . .^~�.----. ome,nr ^^=--._ . -__-----_ `~ <br /> � ----------' VVoh,, To6|o Depth ..3d�------------------------------- ----Rock Size -/��.^1A6J!I,-------- <br /> ' <br /> ' 0mnncetonoores� VVrU //�!.��--------_'Foon6oMom /_��---- Prop. Uno -��-��----- 1' <br /> ' Date ) <br /> (Prev Sanitation Pe,mJ v� ------------------------------------ - --'_—_'_---- , <br /> 3ep�cTonk (Spadfy Requirements) —'----_--�----.-----_--'_-----_'---_---._—__---- <br /> � Diopo,o| Field (Specify Requirements) ------------------------------------------------------- <br /> � ------------------ -------- -- <br /> -----��-----_-----��--- <br /> ---.-----._.----__---__---_-_'_--�--_-- --'--'-- � <br /> '---'------���------��� existing nhe6o6ddio� onrevame *k�e � <br /> U],o*/ex ng o � required / <br /> | hereby certify Hm�� I have prepared this application and t6m*'the work will be dmmw in accordance with Sum Joaquin <br /> |� <br /> ' <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin LmwmU Health District. Home owner or wem- <br /> yn6aqeumsignmture*erKfinwt6efo1|owving, <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any pmrm*m in such manner <br /> 015 tob*com- Compensation laws of California." <br /> | - - ' <br /> ' 3/gno6 _�-' ����(.---------.---_---- Owner <br /> ---- ---'------- --- ------------------------------------------------------------ 'Title --------------------- --------------- -------'--- <br /> (ifother than owner) <br /> FOR DEPARTMENT USE ONLY, <br /> _---------- <br /> APPL|[AT|ON ACCEPTED uY6' -----__---.-�-------'- DATE ^ -- ' <br /> � w ^ ma/e —'-------'- <br /> --' <br /> DU|LD|NG PERMIT ISSUED ------/ ------.--._.—'-'---- _------ <br /> , <br /> ' ------------------------------ <br /> ADDITIONAL <br /> COMMENTS ----_------------_.----_----------'---'-- <br /> �--�_-'---------.—_--_--'----._------.—'----�--_.—.—_.- <br /> -',- <br /> - <br /> -----_-----. <br /> __--_______'____--_--_^��~_.'_.-'_-'_�~-�_'-_-«�_'�-_ <br /> —'--'-- <br /> --- -��< <br /> Final |nypec�onby ..' '' ---/� ----------------------------------------------Date '' --- <br /> ------- SAN <br /> ° <br /> � <br /> N LOCAL HEALTH DISTRICT <br /> E. H. 9 l''88 Rev. 5kx ` <br /> ` .�� <br />