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*.% <br /> FOR OFFICE USE: IOR OFFIC: USE, <br /> APPIICA/ION FOR SANITATION PERMIT <br /> �..... ...._. . IComp{to in Triplicate] (Permit No. <br /> - j This Permit Expires 1 Year From Date Issued I Dot! Issued W��Y. ".7 a <br /> Application is hereby mode to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in r.Qmpl;,nce will, County O:dinance NC. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION /1590 S, Hwy At// .9ts CENSUS TRACT.._...... _._. <br /> Owner's Name al 64:?n STCL_ IC7 pN . /-�Lifyr'•,✓C SC'C r�. j y+_.. . .. Phone ._.. . <br /> Address -� . .. <br /> .. . .......... ... ...._.. <br /> SFTJn r cry 5 77t f .] Zip <br /> et <br /> Confroor's Name k/ 1ft-L-4-C,ft-L-4-C, `( WT CCs H q ill t CµL License or 3333.1 C.r Phone Cj.3-L.:.. 03�. ..... <br /> Installation will serve. Residence X Apartment HouseCommercial Q Trailer Cont L-1 <br /> Llotel [] Other Oi;�/='C.0 _ <br /> Number of living units: I ,. Nun-ober of bedi.,ams "L— Garbage Grinder Lot Size /p <br /> Water Supply: Public System and name ...........Private <br /> Character of soil to a depth of 3 feet: Sand [1 Siit❑ Clay 6l Pea[_� Sandy Loarn_rj Cloy LoomT/ <br /> Hardpan ❑ Adobe 0 Fill Material If yes,type- . __ . .. ]l• <br /> (Plot plan, showing size of to:, locution of system in relation to wells, buildings,etc.must be placed on r e.erse side.) <br /> NEW INSTALLATION: INo septic tank or seepage pit permalt:J if public server is available within 200 feet,] L1 <br /> PACKAGE TREATMENT I I SEPTIC TANK Sze 'yX S lL .`�1 ..X..2.. .. . Liquid Depth <br /> COp061Y 2WCC'GALIype 'PALE"CitSTMaterial WWCAz irdr No. Compartments ------ <br /> Distance <br /> --ZDistance to nearest: Well 1 co ' Foundation 1 O' Prop. Lino <br /> LEACHING LINE 9`Mn No. of Lines ,j Length of each 1.116 Total Length <br /> D' Box C/) Type Filter Materials A'it rC Depth Flier !Asteria] /.i ^'.. __.. . .. ._. ... .. <br /> Distance,to newest: Well ICO' Foundation 140, Property Line <br /> SEEPAGE PIT (�(; Depth 2a' Diameter 146 Number 3 Rxk Filled Yeats No cNt� <br /> Water Table Depth 14DO ' . .. Rock Size <br /> Distance to neureol Well fat" .Foundation le, Prop. Line 5� ._... <br /> REPAIR/ADDITION IPrev. Sonitahon Permit At _ Date ) <br /> Septic Tank (Specify Requirements) <br /> D.spatial Field (Specify Requhemews) .__.. <br /> _..... .... . . _... <br /> i0low ens requrtud a 'ridion on reverse sick) <br /> 1 hereby certify that 1 have piepaied this application and that the work will be den., in accordance with Son Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Nome owner or licensed agents <br /> Signature certifies the following: <br /> "I certify, that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become's/ubjeci to Workmods ,Compensation l(o)ws of Colifo•nia." <br /> Signed �v�es-C�L«y �'AZ a/.-C' ,,_<'ca�( wnav <br /> By.. . <br /> Ilf other than owner; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTECi Ely <br /> DIVISION OF [AND NUMBE ATE <br /> ADDITIONAL CC's:•.ii°:1S %C � ,� <br /> 6-d/-96 _dl�./ <br /> Final Insaeci,on Ly <br /> " li :. �I'. . ._. • .....i'. _ <br />