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AOR OFFICE USE:
<br /> v r:C F tJSt: APPLICATION FOR SANITATION-"RMiT �` �• �j a
<br /> ...... ... C �•"
<br /> ;'a r:' �. i� ,;s f I —I--471 _. P6r�"'nlif N /•.J....�4 7
<br /> f ��p #Complete i& rtpIcate�
<br /> . ............ .................. r,. . . -,ler, .,�
<br /> old 73
<br /> Date Issued
<br /> -- ----- This Permit Expires 1 Year From Date Issued
<br /> ---. �..J.......:....
<br /> Application is hereby-made to the San Joaquin Local-Healt[f bistnct-for aperm to construct and install the work herein
<br /> described..Thivopp4ccation.is.,made in compliance with.Cobrity.Ordinance f4arr&49oaW,existing-Rules,wand.-Regulatjork .:,:r,
<br /> e :, i�1 :rst;Vr. +ir E1`,�; ,•:i� - ' e�. �•` and exis.nng ntrtE s and v,
<br /> JOB ADDRESS/LOCATION . ....-��.3_- ._ ._._..Y.,A_�?..... -c-CC/u f ..CENSUS TRACT .......................
<br /> ��E :� '10Ch ,�:f r!cwtYwroSL tk Cir` 7So
<br /> Owner's Name .,._... .. r ^
<br /> .. . .... . ......A cin Tli
<br /> -------V—................ oSne .-_ .._..............
<br /> ., a...---•-••-•-----•----•-•• Phone
<br /> Address �S'lSl._. ,. .B-P-� U(VarJ AD City SCf)C ry .._ho
<br /> --------------------------------
<br /> Contractor's Name .. .... c.14- .- -...OL- ...`---. 5.,-_T�.1�- -----.--..License # .a-f -'`� . F Phone
<br /> Phone wil� serve: Residence ❑ Apartment House❑ Cammercib E]Trailer Court ❑
<br /> seeve: y�,�Tr<. ilr
<br /> Motel E]Other f<itG Cour,
<br /> o�rr
<br /> Number of living units!.. Number of bedrooms --*—,.Garbage,Grinder,.. ....... . Lot Size ... . . �. ................
<br /> ue } i 5' .r i Ac, Lot Stz,e
<br /> Water Supp�y: i'ublic�ystem and name . ................. I
<br /> S to
<br /> Character b#soil�oWc d�Sth1 0'tb feet: Sand Silt Clo 4.�, 4 Peat Sand Loam Cloy Loam ' I
<br /> P �❑ ❑ Y. ❑ Y ❑ Y ❑
<br /> Hardpan' Adobe [ t*ill Material sr5-. �es,type
<br /> , � --ter`=---- I
<br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)
<br /> L :, i!'lat^r, dan:7„, etc rn!si }, . L r”
<br /> NEW INSTALLATI� I: {IVo septic tank or seepage pit permitted if pul;lic seweris avoilab�e wAirpiodriee�,)
<br /> '� l r. IQ
<br /> . ,s 'rgY,is .- ,t i..
<br /> [ p r �^�' -.. _ Material. 4 0. it4r'ri art pfh ..�`F'.............. 4
<br /> PACKAGE TREATrM NT 9E"TiC TANK Type Size.......... ... .. �]_. t u�p &f i-Ii. W
<br /> Ca acit �r�o T e
<br /> distance to nearest: WOF ' ell � � `�_ �� . " . 3 °q
<br /> .-•_"__--._Foundation ...../..�... .:.. prop. Line ---------•-•--.._.... kffi
<br /> LEACHING LINE K. No. of Lines <;Z, Length of each line Total Length'.- 8W...............
<br /> 'D' Box �� Type Filter Material __ __._Depth Filter Material I .................................
<br /> Distance to nearest: Well ..... Foundation 414�-r ... ... Property Line -
<br /> C
<br /> SEEPAGE PIT [ Depth . -A�.. _... Diameter ..�..... Number . ...... Rock Filled Yes No ❑
<br /> Water Table Depth ---...... '�._T`-----------------------Rock Size4?�__.._------------
<br /> Distance to nearest: Well ..._...........�-.. ................Foundatlorl ------a_.-. '`.... Prop. Line ........^_"4._ '�J
<br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ......---......................... Date -----------------------------------)
<br /> Septic Tank {Specify Requirements} ... .. ...... . ...... ..........._........._.._---------------------------- ............................. A
<br /> Disposal Field (Specify Requirements) ................-...............---......... ----------- "-----'-- .....-'--- ... ... .. . ......................................
<br /> �
<br /> I
<br /> -----•........ ..:............ I-------- ........................... ......--------....... . ---. ........ ' ............. --- ---------------------
<br /> -----------
<br /> ----------------- --------...- . ...."..... .. . .. .. ........ ..........-----'-'----......--- ......... "----'-.......-------" ---- .. .... . ....... .............. ....... -
<br /> (Draw existing and required addition on reverse sidel
<br /> I hereby certify' that I have prepared this application and that the work will be done in accordance with Son Joaquin
<br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen-
<br /> sed agents signature certifies the following:
<br /> "I certify.th.at•in the performance of the work for which this permit is issued, I shall not employ any person in such manner
<br /> as to become subject to Workma ' Compensation laws of California."
<br /> Signed . Owner
<br /> By
<br /> 11 other than owner)
<br /> F R DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY .. .... ............... ............... DATE .. ..... ... A..........-3..... ,
<br /> BUILDING PERMIT ISSUED .-. .... ................... ._. .. ... .......DATE . .._........._........ ........
<br /> ADDITIONAL COMMENTS .. Y>,rC..... ..
<br /> 3----._..S -------- __
<br /> ._......... .... .................... ------- - -"--- ...............
<br /> ------------- ------•---- -"-- ----------------- - '--" ............................. . ................................... ----------------------.-.......
<br /> ..
<br /> '.............. ...... f .
<br /> Final Ins ection b L.tA �.5. .......__.±v +� _
<br /> �! '
<br /> p Y� �-rt....._e�z�--... ... .. ... ..... pate
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t`
<br /> E. H.13 24 1-'68 Rev. 5M 7/72 3 ,K
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