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FOR OFFICE USE: <br /> ....... .......... ... <br /> APPLICATION FS;t SANITATION PERMIT <br /> 1Cor�plefe In Trlpllcahl Permit Na. . I",'± <br /> ........... .... .. . . ..... ......... <br /> This fsermlt Expires 1 Yeer From fish Issued Date Issued .�"•,�`" <br /> Application It hereby made to the San Joaquin local Health District for a permit to r�nstruif and install the worm herein <br /> described. This application I r, ode In Omp;ianco with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LO'..ATION .*� _ ` <br /> •9r��'?r--.'�f... ....C,�..�'.:-'1.E+.37 5. �p.AO ... CENSUS TRACT <br /> OwnerOwner' ..... <br /> 's Name . .QHr.a.... E 'C'.+.F�P.!J.. .... HAQ................. <br /> Address . F� Q o.h. . .`� l C'Ify ....... h -� f,,}'T-S ..... <br /> t <br /> Phone � - 33So <br /> .................... <br /> C.+ntractor• ...... �..... ; <br /> s Name .......... .. ,.i . .�- . ....... . ........License# ........................ Phone ............. <br /> Inst011otion will serve. Residence 0Apartment House Commercial OTroller Court <br /> MotelOther <br /> ...........:.....................:......... , <br /> Number of living { <br /> units•....1..._. Number of bedrooms .........Garbage Grinder VES Lot Size �3A.s:,0a,5,..,...._._ <br /> Water Supply: Public System and name .-...QIr.C.D........L .:4-mo... ..ulc-�... + <br /> Character of coil to a depth of 3 feet: Sand Q Silt[3. Clay I] Peat Sandy Loam fl ".da�raopm T <br /> Hardpan(Q Adobe❑ Fill Motorial .. t <br /> ( .,..........If yes.t1►Pe......................... <br /> Plat plan, showing sire of lot, locntion of system in relation to wells, buildings, etc. must be placed on revaq sie�.'J <br /> NEW(NSTALIATION: (No sep!ic tank or seepage pit permitted If public sewer I 'available within 200 feet) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK�' S xe.. 0 / <br /> —�..� + ......1. � -...... Liquid aj�lh . !� <br /> Capacity .J �'...... Typo ��s.f. Mahrial..sw�rt�errs: No. ConsportmeMs.. ............�. E <br /> Distance to nearest: Well <br /> ..........S. .,'`_.........Foundatlon. ...10.. ....... Prop.Ur» <br /> < » <br /> LEACHING LINE <br /> Na. of Lines . ..........3.- Lersgth of oath line...... ........ Total Longth ...�.�.�.?...»»_: <br /> 'D' Box ..... r' .. Type Filter Material Sr %r:x �'�epth Filter/rllohrlal ... '.. .�........ <br /> +y Distance to nearest Well ... !11.i?...`.i-.:.�Foundation ...... Properly Line SQ. <br /> SEEPAGE PiT Depth .....��.�......., Diameter •;' umber .. .....».» <br /> --�.. /_ j. .. N .... Rods Filled Yet No <br /> Water Table Depth ...I........ I t° <br /> Distance to necrosis Well ...6........ I4t..............Fouttdaffon .......� . +'. Prop, line .... <br /> �j Rf?I►�AIR✓ADp1TiDN(Prov. Sonitotlon Permit#..... ...................................... Dots .........:. <br /> '.i Septic Tank. Requirements) . -�'»»+� <br /> ....... ......................._......................._. ............................. ., <br /> Disposal Field (Specify Requirements) . .................................................... <br /> , <br /> s . i <br /> t .............I................... <br /> .......................................... <br /> prepared.. .... .................. ............... <br /> ........ ..................4.......... .. ..........._.....:.........................................:..................................... <br /> ..... <br /> (Draw existing and required addfe <br /> _addition on vw w tide) <br /> I <br /> f hereby certify that 1 have this applltatlen and that the wank will be dorsi in aceordowe with Sm Js�giilss <br /> County Ordinances, State Laws, and Rules and Regulations of the Sas~ Joaquin Lead HealthfilsMd. Neese awtser er flaw. 1 <br /> sod agents skneture certlfios the following: <br />'t "I certify that in the p•rfo-rnanc• of the work for whlth this pernsif Is Issued, I shall not employ any person In serifs snesuter } <br /> i as to beg • sobject to Workman's Cosfawn of Signedc^JvY`y^?9a (tie Owns <br /> By i!........... ..(IF atther.. ...than....... ownerl . ... Title , <br /> ...... . ................................ .............. ... ... - II <br /> ..T <br /> qF ItEPA MENT OfrLY <br /> � A <br /> APPLICATION ACCEPTED $Y4`'.` <br /> BUILDING PERMIT ISSUED ". .. ............. DATE ... ...r/ � . .... . <br /> ADDITIONAL COMMENTS .....%...... .... ...( ............ ...DATE .. . ... ... .. <br /> ...... <br /> ....... .............. <br /> " .. ...... . .. _..: .. . . ............... .. ........ . ............... <br /> ...................... <br /> ..... ....... . <br /> . . .. ... . . ... <br /> .. . ....... . ... ..... ._ .. ............. .......... <br /> Final Inspection hy! ., . � ./ I <br /> Ir <br /> .. ...... ......................... . .-...........Date � .. ;.AQUIN LOCAL HEALTH DISTRICT - 6/7L 3M <br />