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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {
<br /> ..��................... Permit No.7---�...�
<br /> F
<br /> (complete in Triplicate)
<br />................:..........I........._................. Date issued�.0-71,�,q:�_.?.
<br /> This Permit Expires i Year From Date Issued
<br /> .......................... _.
<br /> Application is hereby-mad.e.to the Son .Joaquin Local Health District for a permit to construct and install the work herein
<br /> described. This application is made• hi"'dompilance with C unty Ordinance No. 549 and existing Rules and Regulations:
<br /> JOB ADDRESS/LOCATIO ... ,. ' • ._.....v-•• Y:.... L..CENSUS�TRACx
<br /> Phone 7X ............
<br /> Ownera MNama . —y � .. , _.. .. _ .�,
<br /> i
<br /> Address1- .. ............... �'ity. .". . . :- alj
<br /> s S ::: License # :::, : Phone .: 6 ...ls
<br /> Contrdttor s : - - -=
<br /> i
<br /> installation will serve: Res9denceApartment'Hovse0 Commrcidi ]Trailer Court' ] ff
<br /> I. . Motel.[]Other
<br /> C
<br /> umber..of ,bedrooms. .Garbo a Grinder Lot Size l,� - - }
<br /> Number of Jiving units N-
<br /> Water Supply: Public System and name;...:•
<br /> --
<br /> Private : 1
<br /> Character of soli to a depth'of 3 feet: Sand❑ , .Silt❑ Cfa`y [] Pea#❑ Sandy Loam ] Clay Loam ❑
<br /> i
<br /> !'Hardpan ❑ Adobe Fill Mc tenial it if yes,;ype .-.-
<br /> rnu's#.:bei I.ated on.: everse alae.}
<br /> {Pot plan shaw�ng,.size..af..Jot, io4atlan:of ,system in,celatlon to'welis,,,buijdingsr�e . P t
<br /> tC� �
<br /> NW INSTALLATION (NO septic tank°.or Pa a P�t,perrnItted if publicewers available within 200 feet,) 1
<br /> PACKAGE TREATMENT' [ ] StPTIC TANK Size..: ..�� -------
<br /> Md
<br /> Liquid Ciepth ...$.V.1... ........
<br /> Capacity! -- TYpe,.t` =• Material �C�L.r No.fiCcrt�partments ... .i
<br /> ; .
<br /> I i
<br /> Distance tot neprest Well .•-• o
<br /> �7 .Foundation j'o Pr p. Line� �. �` •�
<br /> �r9 no. I 7 I Totcl Length
<br /> NG LINE No of Lines ' Pte_._ Length, of eo '. '` •' �?r. •........_..}
<br /> LEACFI I ¢ e F
<br /> — T :e"Filfer';Nlarerial: : =OoOth"'Filter Material / '...:. .... .... . < . ...
<br /> ............
<br /> Distance to newest' �lWelli . .�0
<br /> Y* Foundation 1 Property. Line n :J..
<br /> ♦ 6 �F / Q. . Rock Filled Yes
<br /> I SEJ=PAGE PIT . Depth . � . ,..:,. •'iJiameter/ Nun►ber- :.. .
<br /> Water. Table. .Depth �t ... .'.-..,-....;.Rock Size.f � Z .,.. .,,..r .... °�.... .
<br /> --
<br /> Distanc® to nearest Well -
<br /> .Foundation; op
<br /> r� - !.:� Pr Line
<br /> REPA14/ADDITION(Prey. Sanitation Permft fir.... Date .. _ I... 1
<br /> Septic Tank (Specify Requirements) . .. .. .. •, ��{ J � ...-'�
<br /> I t
<br /> P.
<br /> bisposol Field (Specify Requirements) -- •:--•-- � �
<br /> i 3 { 4
<br /> _... � ..., i ... _.. .. .. ... t...............
<br /> ... .. _._ ...........+ ..................... .................. ...
<br /> _ _.. _ _
<br /> ... .... .... ... ... bbb ... - .. - '
<br /> .................... .... .-.. .:_. ..... .):Draw axis#ir1 and re uir_..�.......�.....,.. ... ---- ._..
<br /> ........:....q.....ed addition on reyerso sidey . I ....... ... ....
<br /> ....-.
<br /> y certify that 1 have prepared this applitation and t at the ,work` w4*ll 6e done in aec0rdanice with ;San; 300: utn�
<br /> hereby g;
<br /> p
<br /> of"&-Spit 3oaggiii'l�bEali'H fiilth"DTitricf:'iH iriii"eWiiie? it�'iitseFj
<br /> seda e.Os�sn nature cs ti#.ies.ha.f-ollov�ines-stud 7te;"utations.......... ..... .:. .....:... ...`.._... ... ._ .. . ... - - - - - ... ... , . ._...
<br /> ty,` ► #
<br /> S S S ;
<br /> ( "I 'certify that in; the performanc4.-of the; ork,for which this permit is issued,I shh6llM�ot en pioy any persois in wsh manner
<br /> . 3
<br /> i Woiicman's Compenpatlon igws of"Califarrir6;"
<br /> as to become sub act to
<br /> Signed ..... _F_
<br /> Owrrei ...
<br /> `, .. .r,. ... .. .. ... ... a -i
<br /> :,... itis
<br /> G ilf of er t a owner) t ... ., ..
<br /> I FO 0EPARTMEN USE ONLY!:
<br /> !. ...........
<br /> - y q
<br /> _ ,....._...,......; DATE _,�� •�J' r. � 1
<br /> BUILDING PERMIT-A, _ .......... I
<br /> APPLICATION ACCEPTED B :
<br /> AdDITIONAL COMMENTS ' '-„ k
<br /> F Cthc .. ...
<br /> ,
<br /> ..... F- ,-_ ....
<br /> i t F,............ _ q1
<br /> Date ,3.
<br /> Iris ection.b ... .,,..-
<br /> Fina p .Y� 4--�-�.�� .. }
<br /> :SA��JOAQUIN `LOCAL HEALTH-i DISIRIC'I'
<br /> 7172
<br /> 3 M
<br /> - �.vzy
<br />
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