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V <br /> FOR OFFICE USE, FOR OFFICE US:»• <br /> APPLICATION I�3R SANITATION 4iieRfdifT <br /> (Complete in Tr(plicate) i Permit No.7tr�_1 V.a' <br /> Dote Issued./ .-5..-7. <br /> This Permit Expires i Yoo?From Data lssued <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work heroin descrilood. <br /> This application is made in compliance with County Ordinance No.549 and existing Rules and Regulations: <br /> l <br /> JOB ADDRESS/LOCATION t ' > 74:�R�!�ur�� '. da. s,.,,,, . .. ...:CENSUS TRACT ............ <br /> Owner's Name <br /> / .. .. .............. ... <br /> Address. , ��-Y..... .. 7.1- ,_.. city... •C:3 irti..... .. . .Zip. <br /> Contractor's Name — -•1�.. Z�, :..r ...'?i!'' ,-License . .: ? � .1�..Phone....... <br /> Installation wi;l serve: Residence❑ Apartment House❑ Commercial Q "Troiler Court [ <br /> Motel ❑ Other............. <br /> Number of living units: Number of bedrooms... -.... -.Garbage Grinder.... .......Lot Size.... .../._A,<..�.................. .. <br /> Water Supply: Public System and name...... ...... _. ............................. ........... �. ................ .... ...... .......... ................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand [J Silt❑ Clay❑. Peat r2- 11.1 Loom❑ Gay Loam❑ <br /> Hardpan ❑ Adobe❑ Fill Material.. .....'_lf yes,type........................... .... <br /> (Plot plan, showing size of lot, location of sy,tem in relation to wells, buildings,etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank o1 seepage pit permitted/if public sewer(s available within 200 feet,) � �J <br /> PACKAGE TREATAAENT ( J SEPTIC TANK pIj Size��/'..� .. ��, _.. . ..liquid Depth.... <br /> ................ .. ... <br /> /.&r pr-o . Line..,.................... <br /> Capacity I�.C..G......Type � -T ..material ...�'-t'1se..........No. Compartments <br /> Distance to nearest.Well ...............-`�-�......................Foundation....... .' p 6 <br /> LEACHING LINE (dJ No. of lines /....................Length of each line....... . Total Total length ........................:. <br /> 'D' Box...._......Type Filter Material.. Depth Death Filter Material........ `±. .......-_ . <br /> Distance to nearest:Well......... �....... rounuation.....L-C.._..............aroperry 'line.....................I............. <br /> SCCA E P1 I Depth a.......Diors>�ter..2..�.1.C..�.Number. . _...1...... ............ , Rock Fiiied Yes u No❑`��-�^ <br /> ,. <br /> Water Table Depth......................1`jGl:.......................Rock Size.... ��.....,d.✓...... .... . ....... . <br /> Distance to nearest:Well...........45.C..A/. ...... ........... Prop, Line.. ...�r��-------- <br /> REPAiR/ADDiTiON (Prev. Sar,.'ation Permit#...... ...........................................Date......... ........................... ...... ) <br /> SepticTank (Specify Requirements) ........ ........... .... . ........................... ... ............ ......... ........................ ......... ................................... <br /> DisposalField (Specify Requirements)............... ...._ .. ... ...... ............................... ............................. ........... ......................... .......... <br /> ......................... .........I.... ............ .... ...... .I.................. . ........ ........ ....................._ .......... <br /> .... . ..... ............... .............. ..._ . .. ...... ............. ........ . .._... ....... ............ ... ............ ...... ._. ..... <br /> (Draw existing and required addition on reverse side) <br /> i hUVQL,7 eortbey tihsc { ;iQvkl ?r�?P cd this applscatilan and that Mit wwk will by mono in accarbonco with San Joaquin Cou"llyp <br /> l,n;inancoa, ;tate Lows, and Rules tussal Regulations of the San Joaquin Local Nocith ;vfstrict• Homo owrmvr or licensed azvnts <br /> 6 jr,aWra cw1ifiaes tho foilowinc: <br /> "1 car iiJ the:4 In trs performance of the work for which thi, permit Is issued, I shall not employ un,; par„on in such n unaer W <br /> to wosar:%Q cu67oct to Wor',eman's Compensation laws of "Ifornia.^ <br /> Sigm:d ..._ /.... _.. .Owner VFJ <br /> � •t ....... ......4y...... Title_ <br /> . .. . ._ .... ... ... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY l`•� ......DATE ! L-'.+� .......... .. . <br /> DIVISIONOF LAND NUMBER _.. ........ ......_ . ........... . ................................................ . .. DATE......... . ...... ...................... ...... <br /> AvDITIONALCOMMENTS . . . ................. ........... . ...................... ..................................................................................... 1. <br /> .................... . .... .... <br /> . ............................................................................................................................... ........ ........ <br /> ....... ...... ... . ��. <br /> Final Insoection by i' .....Date../..?- �� .l _...................... <br /> EM 13 24 J +ra/ SAN JVAQUIN LOCAL HLEALTH DISTRICT fu 21671 AM 7176 3M <br />