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FFICI: �sE: P�- 1C 11x5;`, ��3 tSGON
<br /> L+�
<br /> `'•^` - APPLICATION i v SANITATION P
<br /> ID 'in, s In Triplicate! _ Perr'lir It 110 . 5 O
<br /> ...... ... ........
<br /> ... This Permit Ex i Dabs ued JTS
<br /> - -- - p ns 1 Year From Etatell:aetaed � �
<br /> Application is hereby,made o the San Joaquin Local Health District for a permit to construct and install the work � �
<br /> described. This application s made in compliance with County Ordinance No. 549 and existing Rules and Regulaticmp
<br /> I Q3S_ 113' 1
<br /> JOB t;] ADDRESSAOCATIONp.. II.------ - �1�1: , ....447'14 f OR-CENSUS TRACT
<br /> .Owner's Name ... . ..... . ....:.......:... ........Phone �-=T<---
<br /> Address 1 ..:. .. 1 Q1 � 1/ , _ .•. ., <e � �rr. .Jl,�k� _'� _,
<br /> Contractor's Name .S�_A.�[.�.. 4-s...... B�.� • _,.
<br /> - � ,� - ..License� _ < ,.,,.. .. Phone .............T..r.=„
<br /> Installation will serve: -Residence WApartment House E) Cor awdaf 13Traller .E- °!
<br /> Motel p Other ........
<br /> _-
<br /> Number of living unitse_ Z... Number of bedrooms ......+...�gea Grrinder, Lot Size _/gPeP X.-4 s
<br /> �� �
<br /> Water Supply: Public System and name ../ f ,�` s
<br /> Character of sail to a depth of 3 feet: Sand 0 silt 0 Clay 0 Peiat � �
<br /> i� l�r�dy Laam� Clay loam
<br /> an
<br /> Hard
<br /> - p ❑ Ado be Q Fill Material............!f ye:. ........ .
<br /> (Plot plan, showing size of lot, location of system In relation to wefts, l ,ildi� , . moat,,be placed an reverse owl
<br /> NOW INSTALLATION: .r (No septic tank or seepage pit permitted if ptubfl� sawor is availabfe within 200 feet,)
<br /> PACKAGE TREATMENT it+]- -SEPTIC TANK Sizo,-. ,.. ktquid, paptl4
<br /> CapricityrWf,00...-- Type mctf+eria'1,CA0,09,W No, Compartments
<br /> } Dis once, to nearest: Well .... ........... prop, kine
<br /> LEACHING EINE [ ] No.1of Lines ...3..... .. ....- Length of eadr lie .<.,<_. ... Total Length ...........
<br /> '15"Box x S Type filter Material ,.�t __ .6Nrptl t Mar Materiol . 1�.,� . .'..._........ .........
<br /> Distance to nearest: Well ...... Fourdation ..../Q.. ..-_-,.... Property Line' .......,.. I SEEPAGE-PIT [ ) Depth ... . ............. Diameter . Nvrnfaer Rack FilledYes � ��Water Table Depth ................. Judi:SIS-*Distance to nearest. Well . ...... . .. . .....Foundation ., . .. . Prop, Urs ... ,..eRMREPAIR/ADDITION(Prev. Sanitation Permit ......._.., ,, ;,,,,•,..:.....-- fete . , ....f..... .........Septic Tank (Specify Requirements) ........... , . . . ............. .. . .... ...... . , ...,......., ...Disposal Field (Specify Requirements) ...,...... .,:< ..... ........... .................::. .......•-----=---------------- -----------------=---------•------------------•----• ---•--------- ----.--_................•---..............:.............................................
<br /> (Draw existing and required"ai-ditfon on retrerse sidel
<br /> I hereby certify that I have prepared this application and-that'tbe WO& will be dors! In accordance with Son iia
<br /> County Ordinances, State Laws, and Rules and Regulations_ of the Sart Joaquin Local Heallb,District. Hence owner gw(SpE7M
<br /> sed agents signature certifies the following:
<br /> "I certify that in the performance of the work for which this permit Is Issue$, I dWR act em;day any Iserion In such metes
<br /> as to become'subject to Workman's Compensation laws of California." .+.
<br /> Signed _ ..� /E" _
<br /> By _......_.... •--------------------•---.....----- ---.._.....------••------..._........_.........'jitle .........
<br /> (if other than owner!
<br /> FOR ARTMENT US5 ONLY Z `
<br /> APPLICATION ACCEPTED BY C/�
<br /> BUILDING PERMITISSUED ............. ...................... [... ._......... DATE ...._.:..�L
<br /> ADDITI4NA_ COMMENTS . . : ......... DATE..............,....l,d,....�.........�.„,�.?.�,:.,...:
<br /> . i
<br /> ---------- ------- -------------------.-..-------------------.... --•--------•--.....__. .................
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<br /> ------------------------------..... ....------------------------------------------------
<br /> ----- -----------•-••.....................
<br /> Final Inspection by: _ -��-
<br /> ---------------
<br /> Date ......_.. ..._........ ...........
<br /> ......_...
<br /> EH
<br />• 13 2L 5H SAN JOAQUIN LOCAL !-HEALTH DISTRICT
<br /> 8/7h. 3M
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