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rOR OFFICE USE: r eC� � OFFS �: <br /> 5.,a.AP%CATION FOR SANITATION PERMIT <br /> �. _. c Ga <br /> ,'........------........ Permit No...70. __ -• <br /> ......_...._—. . . <br /> _-_- -"--""-.----- (Cemplero In Triplicate) iF 74� <br /> --------------� � Dare Isawd...�.t?..'_. <br /> . .._.._...•---.__.--..................... This Permit Expires 1 Year From Date,Iseaed - <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constnut and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules acrd Regulations: <br /> JOB ADDRESS/LCK' LTION."--"-�w / 140 ..........CENSUS TRACT. ... •--- <br /> __...__............ ..... <br /> Owners Name MU,-A-196 ......................y ..,...._._ ...... ........_�Fc... <br /> .... <br /> �r _ <br /> ._.L7 •/ ' P!+J............... zipy <br /> ---' ..... _.----------.......----... ...................': CHX.-PAddress.._ <br /> 1�AA1 e/Y ! ,. �r�.',�'�'�-"� <br /> Contractor's Name. _..SCI•_/___r.. ...............•_.-......._..._...............License # /...Yr. -rilir..�".__. . <br /> er TtToTTTr <br /> Installation.�rir11 : + � T'112SU�'(rG : •. - <br /> m a <br /> Motel Q ;Other.../�,�.! /.. �.1y <br /> t <br /> Number of Living unit.:._ ---- ._....Number.of badroomsfiS_..Garbage Grinder..�.'_,\�Sine....=Lr�-�--- } '--'.- -----•- ---'._ <br /> Water Supply: Public System and name.-.: ------- .:`.,�..('.................c44�..__ ...-•---•----'---'.-::•--'--,-, <br /> Character of soft to c depth of 3 feetr Sand❑ .Silt Q CIaY�� Peace❑�1Sy l; Cloy Ladt m Q <br /> '' Hardpan Q Adobe'❑ 1 Fill Ma',terial. .......mfrs es p��� -------- r....... <br /> r <br /> [Plot plan, showing size of lot, location of,system in relation to wells, but ingi,_et+rust be placed on reverse side.) w 4 <br /> NEW INST4LLAT10N: (No:septic tank loi'seepoge pit l semi ted if public sewe'rrtrS`` YHoble within 2 feet,! s v f <br /> •-•------...... --- --- . _ <br /> ...ht <br /> PACKAGE fREATMENT SEPTIC TAN -if] Ze <br /> -......... . ..........Liquid DepM ..........--....... <br /> I atments_ '�.r <br /> Capacity- 7TYnwv :Material...,...:.1......._.... .No. Comp ........... <br /> Ir . "�• .• . <br /> e.. _ Flwt�I/ <br /> . <br /> int .,-._. _.._...._.,...r. <br /> Distanceito.nsarst:.Well_. ip� ._---------- <br /> LEACHING <br /> -. . <br /> LEACHING UNE No. of Lines.: {+... :-,r- nh o _ tot Lengt;_,_.. g !. <br /> Filter ' er Material_.:.._ , / <br /> OQ -_---------- .Property e..�dr........- ...... <br /> Distanceto near: . ... <br /> - <br /> . -.Diameter...----,_...—...NNN000MMM.l=R •. - <br /> SEEPAGE : Depth.---?........ _ -•�- -•.-..._t ......---1 . . <br /> i <br /> 'Water Table Depth_....----:_.----.._._.....c.�.� •-•--:-•------�7�"' Slzeii_--..?..._..r...._._.....1..._:......... <br /> r Dis%nce to nearest: Well.r....:..::....._::..;.�. en't'.___,._:..v_...._. . line.._.._.._.....-__.—a,.ki <br /> .. <br /> i <br /> REPAIR/ADDITION (Prev:Sanitation Permit#f........_...:.........`...._. ..__t .....] <br /> Septic Tank (Specify RequirerrytntsJ._-., i ^-;-- .--.,:r::,..4.::;:.._......._...._.._, ':---'-.......... <br /> 1 e <br /> Disposal Fiild (Specify Requifemd�rtll - �_ ___1 ....._ -_.-- -----.—•_..t._ <br /> : I <br /> i <br /> V4Diaw-existing and required oddifion n everse side) .--.•- --. •-. ] <br /> I hereby certify that I have prepared thiNklicatlon and that the work wiil`be done in accordance with San Joaquin County j <br /> Ordinances State Laws, and Rules and �gulatlons of. the San Joaquifr'r ocal Health District. Hometwner or licensed agents ,f <br /> signature cirtifles the following; <br /> "I certify thrat In the pe rmffncsl el a work fef trihleh'fhis perm(t is issu 1 hall net employ any person in such ieannsr as <br /> to 1»ceme rsub ct t n s pen on laws of C lifamia ' ] <br /> Signed . < 1....: . . .. .;Owner .... ;. . . <br /> By. ....................._... ..+. .,........... Title :':T" <br /> Alf other than•owner► ~ <br /> _ . . —a... � •pEPARTM T tllE ONLY t - <br /> APPLICATION ACCEPTED BY,-. - _ -- ... - -- -------------- .:---- ...DATE i_.� <br /> r . . -. <br /> -. --- 77:......-'.---,...--..•:w..1._D�DIVISION OF LAND NUMBER------- <br /> ---------------- <br /> - -- .. ---' .........-..- <br /> . <br /> DDITIQbIOJCOMMENT5� -- <br /> _:._.. <br /> ::.... 3 ... - :........ ------ -------.............................. <br /> _._. . <br /> _ ............. <br /> ....... <br /> Flnal.Inspection byi, ....-.:.. -..........d---------- <br /> ...............Dul+ <br /> 11,1424 SAN JOAQUI OCAL HEALTH DISTRICT FU 2107 T"jv 6 31A <br />