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' FOR OFFICE USE:
<br /> eEr,/ ..��1� APPLICATION FOR SANITATION PERMIT
<br /> -� �..tGomptete is Tripllcatel -. Permit No.
<br /> lfe.e::er::elenr„e1,1�. �. This Pertrtlt Expires; 1 Year 'rte Date Issved ji-/
<br /> •• .........- •• ••• Date rn,esnnrer..
<br /> 6 ApPlication Is hereby made to the San Joaquin Lacal Health District for a permit to�c�on kucl' d'Install the e
<br /> d,as€ribed. This application is .rade in compliance with Count Ordinance No. 549 and exists Rules and awed �lEtrlh
<br /> _ �wlaffo�
<br /> JOS ADDRESS/LOCATION ,`�. �'�'' ..l`I.o.,.Q �.�!S� �r���. is +�p�/�T
<br /> Owner's Name .. 5 L� I ^ r ,c IE�iL C cee +n'•xxtaera wren,
<br /> r:Y ?... _. T�`:z- _( ria }G u .r ari'� j2 e.e ...-Phone jlp
<br /> Address
<br /> ............. rr C1tT ,r l•, .c1�.7 '`:� .,. ....................
<br /> . :r,..r•r e3jnerre rarer_.. '
<br /> •J '•4.-• •elect ,rs•rt.. SC
<br /> Contractor's Narfse .1 ,�> y£.�e' ... :.. h !mss ,... t11 . e � /..77r... Phone
<br /> E ••` -'• ••.ercrre..erelseee.ir•»:rnLRF>af'i!e !.•vest/n roes
<br /> Installation will serve: Residence Q Apartment"*W CommercWI
<br /> 0%Itee avat �
<br /> Motel pother
<br /> A f
<br /> Illt+mlr of living units:.�Y �. Number of bedrooms .!Y aG�I Lwkiln
<br /> r<e..r._•.♦rs.eeee.ae.e..e••r,reerereevaee_n
<br /> Wdler Supply: Public System and name
<br /> ---' '•. ,••rr-•e• ••»«re•reeeletelv�recce.•�e,ecce.re.re.ean.:..Ora.......l--r---e.-......
<br /> rrevrli
<br /> Character of soil to a depth of 3 feet: Sand . Silt ] •Oats 0 i
<br /> D C3 ClOy!mm�
<br /> f Hard yy�
<br /> pan� 'Adams-� �l�s_tlrrit�I a.e.,aeea.e•�
<br /> __ .. _... a •see,aee.a. �
<br /> Plot pian, showing size of'lot, location of system in r+ltfathm to We%. NdMft4M ate. must be plain on (am”
<br /> NEW INSTALLATIONs (No septic tank or seepage pit perrnitttpl if pilo IRWW is amilWa within 200 feet.1
<br /> PACKAGE TREATMENT ( ] SEPTIC TAW g �r:•e��:�a �� .r r ..tree
<br /> �lq�id nth .
<br /> aaer..e cee erj'e __ r,e -�aarnaeeaa•se
<br /> Tyfae! �- ,. .. � G®?�Cr[ e- No. _ rrtpafttit � _
<br /> psi er .�
<br /> ` Distance„to nearest: Well r. " f�. .1e
<br /> caa.l eer.rt.aeeeae . e....e.:• Pr01e I �tr eeeGnee
<br /> LEACHING LINE No. of Lines .... ......... lertgttl`t I .. f..,...;.......,.- rata! Length . ;� e ......,••..,•..
<br /> Q Sax .: 1..,.:.. Type Filter Material .,(Ta±'..... tical .,:.1�,�,ln:�. '
<br /> Distance fo'nie6rest: Well'.Al Fauftdtpi� �Q , <
<br /> SEEPAGE PIT I Depth .. ...... Diameter ,....., Property
<br /> .. .... Attar ...: .e,.. Rock Filled Yes 13'' !4b .
<br /> Water Table Depth .......... .•l,1 .,r.
<br /> ,. .._•.A Ilio ..
<br /> _ Distance to nearest: well ...............
<br /> .... .,.,.,...(+ ®�• Itta.
<br /> ... •.,. .. ..ae.•...e�'e"` e.x•............. .•.....e•••weeeeree
<br /> REPAIR/ rm
<br /> ADDIT1ON(Prev.(PreySanitation Pit# ..... .. . ., .
<br /> trs. , ... . e .•ea ees.•ae, . 0010a•ear•eo..•ee•.,.ITT,..•.ar:e...-� � ..
<br /> Septic Tank (Specify Requirements).............................. ...e,.cc..ee...•aee. e. ee,...r....•e.....................,................ .......... 1
<br /> Dlsposai Field !Specify Requirements) ...... ...........:..... .......................... � i
<br /> .. _ ............. ,. ......................••••- r._
<br /> .................... ., -.,•.......• ..-.e......•...e•..r,,...,......•....................................,..,..,•- .Ij•r.^.,....e.,,•
<br /> ...........................................____-_-_.______'__- us
<br /> .e ...
<br /> ...................•--.......:...:••«...•.,.......r•...•«.,.•cee........,...�.......<.•......:..:..,.<..:..,...ee,r,•e��L.a..,,.••...
<br /> (Draw existing and required ey"IM" * 4tn alae'. . 'o ,
<br /> 1 hereby certify that I have prepared this'application and that tate woflt will-be done' in accordance with Saj
<br /> County Ordinances, State Laws, and Rules and Reg ulations�of the San loagtrbt liecal peallk Dlsldd.Raffle awoe%W(
<br /> sedr agents signature certifies the following:
<br /> "I certify that In the performance of the work for'which this permit h kstred. I sefadi slot employ any person In sech imto
<br /> as to become sublect to Workman's Compensation laws of Califeenice"
<br /> Signed
<br /> ___------ -------- ......... ............11....... Owner
<br /> By _•cit- �o Title .11�o... �
<br /> (If other tha�w� ...__,_.. �. �. .................................. ......
<br /> FOR GEpART l:Nt ube ONLY jl
<br /> APPLICATION ACCEPTED 6Y .... . ........ ........DATE ....._ --,
<br /> BUILDING PERMIT ISSUED -....... .....
<br /> ADDITIONAL COMMENTS .--- -•------------- ------- -- DATE
<br /> ._.............. .. .......... -__ -------._........-.......................
<br /> ......._ .... _
<br /> . _. ...--- _---
<br /> . ---•-----•----
<br /> -•-•----
<br /> _ ..... ...............................
<br /> ..._._._._ ....
<br /> Final Inspection by
<br /> . ............ :.. .. ate .
<br /> EH 13 2h 1-68 Rev. �
<br /> 5AN JOAQIJIN LOCAL HEALTH DISTRICT
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