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-......FOR OFFICE USE; a <br /> APPLICAT#ON FOR SANITATION PERMk] <br /> ` <br /> Permit No �.�-h )) <br /> . ............................... 3 <br /> (complete In Triplicate) rE r <br /> ........................................................ Date Issued <br /> - _::................_...................... ...-_..._. This Permit Expires l YOM From Date Issued -= <br /> -'-Application Is hereby made to the ;Un Joaquin Lxal Health Di:�,tri,t for a permit to construct and a Install the work �`. <br /> "described.-This application is made incompliancewith Countl` Ordinance No. Sd9-and existing Ruin and ReguitttionUr <br /> s+ - <br /> J08EADDRESS/LOCATION ,/.�"..P��-..-1�.....�W.j/.�....5J =�..... ...�„�..J' ��T�`� ¢3,�� <br /> Owner's Name /. ,.-.. ,..�/"�'�e/S.on/....ls> il*&.�v-!�4/t .. <br /> % ....<ry,.t'.. ...<C.A 1��.G"•�fyY.......... ... .... ........_. - - _ <br /> CENSUS <br /> e:4;70 <br /> -------- <br /> Add S.. �...... _e moi <br /> C - G94'n1 <br /> Controctor's N .......Liesnse+i <br /> Phone <br /> r { <br /> Installation will serve: Residence EDApartment House♦_'] Commercial OTrailer Cour: „:d( �,.(W;;�. <br /> Motel❑Other.........:............................_.. <br /> �} Numbor of living units:. .W...... Number of bedrooms ..._.......Gwbitge Grindrr ..... Lot Size <br /> ,Wotar Supply: Publics stem and name .. I ................._........_..... ._... Priv <br /> CharacN of soil to a depth of 3 feeh Sand'❑ Silt[3 Clay [j Peart❑ Sand Loam. Clay Loom <br /> ' I Hardpan❑ Adobe ❑ Fill Meteriai ............if yes,typo. •-- <br /> (Plot iplon, showing size of lot, location of s stem in rotation o wells, buildings, eta must be plated,on <br /> r NEW INSTALLATION- (No septic tank or soepaga pit permitted if public sewer is available within 200 feeP� <br /> PACKAGE TREATMENT { ] SEPTIC TANK t.] Size .. ... Liquid Depth �•+{„7,:{' <br /> < I Capacity .................... Type .........: ...... .Material No Comparfn+ents ' Rf +O�s <br /> ' a Distance to nearest: Well ........... Foundation Prop Ltne <br /> r................... <br /> LEACHING LINE {.], No. of Lines ........................ LenO,h of each linel.— .:.:t Tota( CengTh`"""5y <br /> r - 'D' Box ........... Type Filter Material ....................Depth Filt i materla( _ <br /> r{f <br /> - . .. <br /> -- ( ' G.t Prop" <br /> ro <br /> Distance to nearest, Well ............. .... F+eundatwn ' // P� <br /> SEEPAGE PI? :.De f, •-.- Diameter Number .,.-tiRocK-IFil�ed j Yes <br /> [ ] P .--......... ..... <br /> Water Table Depth ............_....._.. RockSizo <br /> `>• <br /> .> I.. Line-.7,: ....t..'s <br /> f Distance to nearest:Well ............... :Foundation Prop � a ) <br /> REPAIR/ADDITION(Prov. Sanitation Permit' .....-.......__i.., Tate--- <br /> SepiicTank (SFecify..Itaquireinentsl ..... ................. ..._ _ <br /> • .' ; .GA'�p..y.�e --7Gf.�.�.-..r._.�.•lra/��..�....s'lt'�t,�L+��..�c.. 'FGG"^• ` i+.• . <br /> Disposal Field (Specify F.oqu(rementslc°`� •" •••'�-e•�'�i <br /> (Draw existing and requ red add!C�••,sn •.verse .de) <br /> I hatabY certify Ana! I, huv pmpanrd this application oral that the work will be dons in aerordanu with Sore JOesls In rpt:. '� <br /> - - County Ordinance%, .510a Laws,.and Rules and Regu(aff"m of the:San Joaquin Local Health Gls:rict. Herne owner or Iran- - '• <br /> r sed agents signature ir!lfins the following: <br /> I certify t-signkit the performance of the w=k for which this permit Is issued, I shall not "Play -ay person in such Warm <br /> as to'become subject to'Nerkmem's Compansation laws oficailfomla." <br /> r Signe -• .... ......... ....._.....................Owner <br /> .. <br /> - ' - -f s.-u!s��.. ( 7!tleG.a sr< ........ ... ............ <br /> it I <br /> 0 (If other than owner) -. <br /> - •'`�� �Jj��JFOR DEPARYMENT USF 014LY <br /> z .v - APPLICATION ACCEPTED BY.......00.1 6. 479 %^.......... ....._.......................... ...'...�.... <br /> ACCT DAN <br /> IO PERMIT ISSUED................................_............... ............. ........DATE 71q, <br /> i <br /> s ACCTTIONhI COMMENTS............................................................._._....._......................................... <br /> ....._.._ L , <br /> ._.._.._.........................._..._....._._......................... ........................................__........................... ._._ <br /> _._ <br /> - ...... .................................._...._.. Da .. <br /> -... ...............'.-.-...'•---..... is..... ....... .. .... <br /> Final Inspection by: ..._... ~..- .............................-........................_.... . .... ... { <br /> , <br /> SAN JOAOTN LOCAL HEALTH DISTRICT ( i <br /> F H-7 l,'68 Rev. 5M .,.. - <br /> ........._._.s,.�.tea-_.... .._..--«.a..,u-.,..i.. f...-•--- .: <br /> r{ <br />