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,� FOR OFFICE USE, <br /> FOR OFFICE USE: /'APPLICATION FOR SANITATIONTE 33� <br /> Permit No <br /> --- -- <br /> ............. . . -- -- ----- _ <br /> - •---- --"�-----�- ---- {Complete in Triplicate! <br /> _ Date suecl5"`.'-/)--7$ <br /> This Permit Expires 1 Year From Date Issued <br /> •- l and exisrin `Rules and Regu 'tions;. <br /> Application is hereby made totheSan Joaquin Local Health-District for a' ermit to construct and�inst 4�the work herein described. ' <br /> This application is made in compliance,with County Ordinance 549 ..9 <br /> 1 <br /> ° <br /> C SUS TRACT_------ - ----------- -- -. <br /> JOB ADDRESS/LOCATION.- -... _. .... - -------J--------- ---- -- ------- <br /> ----- Phone....... .....: ........ <br /> Owner's Name. <br /> , <br /> P -.- - <br /> � <br /> Address--�---- � "....... - _._....----.City - � CT f <br /> --. <br /> License-*' . IPhone.. .;/ <br /> Contractor's Name... .. .._ <br /> Installation will serve: Residence [4 Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑. Other---------........ ----------------- <br /> Number <br /> - -- ---- y <br /> Number of bedrooms:--105 -..Garbage G�indar'_....__. .-Lot Size--.. <br /> Number of living units-. ........ ! i Private <br /> Water Supply: Public System and name.................f <br /> -. --• --- ------ <br /> I. If s t <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Peat andy Loam ❑ Clay Loam ❑ <br /> " <br /> Hardpan ❑ Adobe ❑ Fill Materia - Y YPe-�-�---•-------'--�----"-"� <br /> P <br /> (Plot plan, showing size of lot, location,of system in relation to w s, i ings, etc, must be placed on reverse side.]. <br /> NEW INSTALLATION: (No septic tarik or seepage pit permitte• if blit sewer is available within 200 feet,] <br /> Liquid uid De th --------- - ' <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size .. -X-/ . q P <br />'€ s No. Compartments--_ - ------------ <br /> } Q erial... ... <br /> Capacrty..�p��- ..Type--=ICT -- �..- -- <br /> Distance to nearest: Well.-_...- <br /> ----- ---Foundation.-=--�a --- - -- ...Prop. Line.. ............... ..... . <br /> ".Len tl1 edcki line. .-b - Total Length ..1 '7--0)------------------------- <br /> LEACHING <br /> - --------- !_ <br /> f LEACHING LINE [ ] No. of Lines _.--.v - ---• - - ►' <br />! `D' Box. Type Filter Materi f . Depth Filter Materia ... <br /> l.l.... .._"-"............. <br /> I. <br /> ..Property Line- ---------------- .._..t- <br /> Disposal <br /> - ---...Foundation.----•-----------•-�- -- P YDistance to nearest: Well--- --_ Rock Filled Yes No <br /> SEEPAGE PIT [ ] P - --....,Number-. - �- -------•----De th.-.�.b- .._Diameter.._.. flock Size... <br /> Water Table Depth.._..-_.Distance to nearest: - �/------•Foundation--------------- --- ---Prop. Line.REPAIR/ADDITION (Prev. Sanitation Permit#.. - - -.. --•--•-.Date-------------- ------ -Septic Tank (Specify Requirements).--- -----" -- ------------------- - --- --------- --------•.....Field (specify Requirements <br /> ! } <br /> E � [ ow existing and required addition on reverse side) <br /> ance with <br /> f I hereby certify that { have prepared t s application anOfthat t5�n Joaquin work lbe Lo aldone in l•lealth Distrctd, Home owner or oaqu <br /> licensed agents <br /> Ordinances, State Laws, and Rules and Regulations <br /> signature certifies the following: person in such manner as <br /> "I certify that in the performanc of the work for which this permit is issued, I shall not employ any <br /> to become subject to Workma s Compensation laws of California." <br /> Signed... ......... ----- <br /> --- --- ------ -Owner <br /> ' .. <br /> By........ <br /> - -- -�� Title............................. ... .. . <br /> ( <br /> (if then than own ) <br /> �O DEP TMENT USE ONLY <br /> ------ -DATE - <br /> APPLICATION ACCEP D BY_.....-"--. <br /> ---------------------- -------"---- - ---� ...._ <br /> i DIVISION OF LAND UMBER.--------------- -- --- -- ---- .. . <br /> ADDITIONAL CO ENTS... ------------- ....._......_.. <br /> ............. ...... <br /> %. ...... ........_---.._-:------ <br /> ----------- ... ------ • ------- ---• ---- <br /> - •-------•-•---•----•----•---------------- ------- --X=-- -•--,--:_-----.--------•---•-=:------- ---- --'----------- =-•------------".---- .--Date ----- ------ -- --.. ........ .---- <br /> Final Inspection by:................"�-'.-- .... .. Fay 21677 REV. 7/76 <br /> EH 13 24 %'" SAN JOAQUIN LOCAL HEALTH DISTRICT <br />