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t <br /> i <br /> + FOR OFFICE USE -APPLICATIO-N FOR SANITATION P� <br /> .... ..... . .. ............... <br /> (CempleN in Triplicate) <br /> . ............. ..........I............ <br /> _ Date Issued <br /> - This Permit Expinn 1 Year From Delve Issued <br /> Applicatlan Is hereby made to-he San Joaquln local Health District for a permit to construct and install the work hefein <br /> descrlbed.This application is made In compliance wit County Ordl n�i''No. 549 and existing Rules and Repubfiamr., <br /> z ,�trw <br /> JOB ADDRESS/1.OCATI .�.�..>�.6..7... ....I Ll.rrr.+.:�•f.... I�..�f.":................cENst>s TRacT ._.O._re.--.......... <br /> Owner's Name ... ... . r • . <br /> /rot�P,rL...._............................................:...... <br /> Address ..........__.............. ....... ......�.7 0..T..r�.... /Wert.<�. rz.�tCity......_ .. ..RDx'l..................I......I......I................ <br /> Contractor's ...........................................................f.......License! ...../....................Pho"v —....................._. <br /> i installation will serve: Residence❑Apartment Hoose{] Commemlal roller c'aad 0 <br /> Yty {.tel rrr t <br /> SMotel❑Other......................................._. <br /> Number of Irving units:-..�...... Number of bedroocr+s .3.......Garbage Grinder . ........ . Lot Size <br /> Water Supp!-/: Pub!Ic System and name _.........PrhmN . <br /> I Character of soil to a depth of 3 feet, Sand o Silt❑ Goy ❑ Peat❑ Sandy.Loam M Clai Loom 0 <br /> Hardpan❑ Adobe❑ Fill Material............If yes,hgsa........................... <br /> (Plot loan, showing size of lot, location of syttem In relation to welt, buildings, oK. r.wst be Placed On reverse stdt.) <br /> NEW INSTALLATIONr (No septic tank or seepage pit permitted if Pubik sewer is available within 9.08':eet,1 ; <br /> PACKAGE TREITMENT ( j SEPTIC TANK Slse..! .x.�:..�:f�a...........I..... Liquid Depth ..y..^'......._.._. 6 <br /> Capacity ....... Ty,,Vyr. ....zrn.`M.!, MaMIai-4M.''.-......... No, Compartments .. •'�.__.v... 4 <br /> Distance to nearest, Wall .... .4_�.:✓`..................Foundation.�.Q.'a'......._. Prop.Una....i�.. .....__."� <br /> 3' LEACHING.LINE No. of Lines ... .... ......... Length of�7i4ch llne ..Zc!.................. Total Length .a2.`.S?......._.._.. T'f <br /> 'D' Box ./ .. Type Filter Materiel ,N:. .......Depth Filter Maholal L.L.......... <br /> Distance to nearest, Well .,1'"0.'.............. Foundation ..,l.4................ Property Line 1( .................. �y <br /> aDap►h'.............e--Diameter- ........ A{werlvr-........................... Roefe - 7 <br /> VrhsNr-Sabls.AePth-..,.............................................R-^4 Size. .................. C' <br /> - Dh'=•"_ rrearesrt'V9ltt-......................................FturioNon, .................. Prop. Line ............. �1 <br /> 1EPAIR/ADUMONlPrev.Soniratioe Permit#... ....................................... Dote ..................................i <br /> ;reptk Tank (Specify Regvire,nentsl ........................................................ . ..........__...._......................._.._........_...._.:.....:: <br /> Disposal Fleld (Specify Requiremnnts) ........................................................................................................................... <br /> .........� <br /> .......---.... ......_.............................. ......................................................_....................................................._............................ <br /> .. <br /> .............. .................... _......... ......................... _ ...... <br /> ... ............................_......................... -.........._ —(Draw existing and required addition on row"sldo) <br /> I hereby certify that I have preporod this aPPBcati" and that the work will Lv dorso M accordance with Goin Jeagvlee_ <br /> County Ordinances, Vote Laws, and Rules and R.gulations of the San ;oaquin Local Heads District.Htme ewnM er Nott- <br /> sed agents siSnatvre csrtiftes the followings - <br /> "I crrrify that In the p*dermmace of+the we-k for which this permit is Issued, I shall not.etpsay eny Pwsen In sect 0113+0tx' <br /> as Ice bl'CtA subjeN moj`-/C,ompons`ationnlaw�s of California ' <br /> Signed .t- � ...(/. Yom'" - . .......... Owner 1 <br /> 6,t' ... <br /> By .-....._.... . ..... ... .. .. . ... ....... . ... ............ .. 71t1e ....._....._. .... ...... .... _....... ......... ......... "J <br /> jif other than owner) <br /> «n � FOR DEPARTMENT USE ONLY - <br /> APPLICATION ACCEPTED BY./,'.. . - .�.Gaa!t ........... .... D4fE ......... <br /> BUILDING PERM;r ISSUED .. .. ..... . j... .... ._..... .... . ... DATE . ......_ .. <br /> ADDITIONAL i:OMMENTS ...1L0 ...s.//�G��7PJl -.QGtEyyr- -.rCfrlG fig. /e✓E'J • <br /> Lfi✓1x//.rd.Sr/ee((israj...La�r..,y. L..lm.r<.r�72. ..-G.Jct..'.w. 1.r.:wyap.. <br /> L. �'rMJ. es.�,�,«,✓.i/x"o�'.r.(.to.«.f.lam-..f' /7'�it+.�".i,...,jeefiy.e...,,. <br /> .................................................................. ..:............ <br /> Final ins ectio:.6 ._................ ........................................Date . ._7. .. <br /> ........ <br /> �d ' -r2I 13 211 1-6R Rev SA"J JOAQUIN LOCAL HEALTH DISTRICT 8/7h 317 <br />