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�- ..i <br /> FOR OFFICE USE: ,, FOR OFFICE USE: <br /> APPI'CATION FOR SANITATION PERMIT f <br /> ...... .. ........... . <br /> I (Comp4le in Triplicate) Permit No. <br /> ...-" This Permit Expires I Year From Dote Issued Date Issued 6-/$7".7e <br /> APPlic'arion is hereby made to file Son Joaquin Local Healtn District for o permit to construct and install the work herein described. <br /> This application is mmde in co'm/pl•ance with County Ordinance No.549 and existing Rules and Regulations; <br /> JOB ADDRESS/LOCAT!ON 4&"?a 'V y 09y . . . .9Js Z1 .CENSUS TRACT.. . ..._ _._.. _ .. <br /> Owner's Name _S7-Cc' K <br /> . � M� -.(-JC(rNHi57"6 5' rr= f'1'... __ . Phone <br /> Address <br /> S/+6'1 E) city. . ST7lrl - .zip_ <br /> Conlroctor's Name L/ A-L-LE Y kbl cFe 11 Q r-1 t C&1.-L.- License # 33.33.( q Phone r7 Q3(....... <br /> Installotiots will serve: Residence X Apartment House - Commercial C1 Trailer Court <br /> Morel ❑ Other Op- ,C- <br /> Number <br /> CNumber of living units. Number of bedrooms ' Garbage Grinder -. .Lot Size..... 1p rT L 2 r.p <br /> Water Supply: Public System and name _.......Private 8" <br /> Character of sod to o depth of 3 le_r: Sand[. Silt C. Clay Ti7� Peat U Sandy Loam[] Clay Loom T7� J` <br /> Hardpan V Adobe[] fill Mater•al/(' If yes, type 7L <br /> 114at Plan, showing^size of lot, location of system in relation to welts I.uddings,etc,must be placed on,everse side.) <br /> NEW INSTALLATION: lNo septic rank or seepage pit pe•milleJ if pubic sewer is available walim 100 feet,) Ll <br /> PACKAGE TREATMENT 1 I SEPTIC TANK kA Site , <br /> VV yXS �T 9 n 2_ Liquid Depth.Sl.y_. /.,._Q <br /> Capacity.zt/CC G,IQype 'ist_tF-CF1fTMotenol GCNQAC TF No. Compartments-._.'Z .............. <br /> Distance to nearest. 'Neil too . Fourdonon 10' Prop. Line _...5.,. .... .. _A <br /> LEACHING LINE MM No. of Lincs ,� Leo- th of each fine - _ <br /> Y` 3 �C Total Lecgrh _/.�^.Q.'.........__..... <br /> 'D' Sox CQ Type FJter(Aoteriol5 At° Ctc_ Depth Fi4er Material 19 - <br /> Do <br /> moi "Die lance to nearest: Well 100' Foundotion IC'.. Property Line _. :S..f...__ . ....... <br /> SEEPAGE PIT Depth -2-!;" Diameter rf f't' IJumner ,3 _ Rock Filled Ye-A No EN <br /> Water Tattle Depth . Ie0 a _. Rock Size <br /> Distance to neoresli Well loot _Foundation. IG., Prop. Line Sr. - ...... <br /> REPAIR/ADDITION (Pre+. Sunitm,on Permit# Date i <br /> Septic Toni, (Specify Recivatimentsl <br /> Disposal Field (Specify Requuertsrnts) <br /> i0tovv eel:,n-q and required addition on reverse side) <br /> 1 hereby Codify that I have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> Ordinances, Star* Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or )Teemed agents <br /> signature codifies the following: <br /> 6*1 C"fy that in the peda,rmonce of the work for whim this permit is issued, 1 shall not employ any person in such manner as <br /> to became wb)tc{, to Workman s ,compensation laws of Cabfmnia.•• <br /> Signed Vc �/L/4 If 1�a•�lcCw�� c I O,nnv <br /> —� (J <br /> fly.. ,/e-lls.,� +��.•-�y,.�-^-C r,iie <br /> Ilf other than o.vneri <br /> -•a- <br /> TOR DEPARTMENT USE ONLY <br /> APPUCATK+N CCEPT <br /> AED BY - .' pgrE- � <br /> - <br /> DIVISION OF Lr'ND NUrdBt DATE <br /> ADDITIONAL COMMENT' <br /> ._ <br /> Final Inso"i.on by- fSQ .,,�. 61-7 7F <br /> e,i'f " SAN JOAQU',J LOCA. _+.l T.? Dij;RICi •+s svr .Fr :vsw <br />