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FOR OFFICE USE: ,t <br /> APPLICATION POR $Ap"ATM PlRMIT FOR OFFICE USE. <br /> ---... M T0404ieaes) Permit Na...7?. :T'-,';Fe,z <br /> This Psirmo Expires I Yea►Prewt om Issued Date Issued. ..F..'11.•>> <br /> APPliCation is hereby made i, <br /> theSon <br /> Joaquin Local <br /> Health District for p <br /> This application is :node in compliance with Peg'- it to construct and instaft the work herein dowibed <br /> County Ordirwnoa No. 'S�9 and existing Rules and Pegvlations. <br /> 106 ADDRESS/LOCA-ION E/S...Koster Rd.......7QO.'. X,-_..DurbAM..Fe.rry-..Rd....�SUS TRAa.255-540.-1Q.... <br /> Owner•• Name ... .. -7ohn..and..Robert. .Dogetti,.. . <br /> Addre 3$59 Shiloh Rd, PMrorre 537-3gS3 ,... <br /> CW«~6 "MWcity Modes w Zip 95551 ....... <br /> instaflatiort will serve Jce Pher+e. ............. <br /> .......... N <br /> Residen <br /> © Apartment Hausa C] 0 �Commercial Q Trailer Court , <br /> Motel © Other.............. 1 <br /> Number of living units. Motel <br /> of bedrooms....Z....... <br /> Water Supply: Public m Garbage Grinder-0,.••-•.,Lot Size............. <br /> System and cam •Sllt Cla <br /> ❑........y© peat <br /> Character of soil toad __. .................y...__.. 0 Cloy loam� <br /> depth of 3 Iaetr Sand - .__.......Private <br /> � Sand Loam <br /> Hardpan Q Adobe o Fill Material..<_.......If yes.type....-........... <br /> (Plat Plan <br /> NEW . showing size of lot, location of system in relation to wells, buildings,etc must be placed on reverse side.) <br /> 1fWAUATION-' (No septic tank or seepage Pit Permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENTI I SEPTIC TANK Dif <br /> Size.................................. -.-Liquid Depth ..... <br /> capacity (1.-.G..Type.......................Material._ . . ...... ... ..._..No. Com <br /> Ize <br /> Distance to nearest: Well.. ......_--...1,OQ.-ft Pa terrts.._.._..;Z .. <br /> ......- Foundation ............ <br /> LEACHING LINE - ....... Prop. Line................... <br /> No. of Lmes._....... zt <br /> .�................Length of each line. ......9.0 -----.........Total Length2,7.0......... <br /> 'D' Box............Type Filter Material........ .._......Depth Filter Material................... <br /> Distance to <br /> nearest:Weil.... IDQ...ft ..-...foundation...... .. ... ......_.....Pro <br /> SEEPAGE PIT [ petty lino..---- _ <br /> �h...... .. ------Diameter. . .....- . ..... Number................. ... ---- Rock Filled Yes� No <br /> Water Table Depth... .......Rock Size. ....--.... ...... <br /> Distance to nearest: Well ..... ... ........_............ - ..- .Feundation . ...- ....... . <br /> ..Prop. Line. . . --_._•,_ <br /> REPAWADOIYM (Prev. Sanitation Permit-*.. ....------. <br /> _... ........ ...... ... .... .! <br /> Septic Tank(Specify Requirernantsl..... <br /> ... ....... . <br /> Disposal Field (Specify Requi►er►►entsl........... ........ . . --•-- -- .. . ..... ... ..... . ................... <br /> _. .... . . <br /> (Draw existin and .... .... ... ...... <br /> 9 required addition on - <br /> 1 oY oerfHr ilia►1 Neve reverse side! <br /> Ordiateneee State laws, and Rue *WaPPgaee end that the work will he done in oeco.dance with Sen Joaquin <br /> >tegsrlatiews of fire San Jeegvin Local Health Distriet. Home owner er licensed" <br /> sigs1eAwe eeafifies the following: <br /> "I C'"I'lili that in the performance of the werir for whichto this permit Is issued, I shell net employ becerrre ;zi. <br /> w laws of California.- P°I' �' ISO^ in such rwanwer as <br /> Signed........ e � <br /> By................... Owner <br /> ... .......... ........ ..... �- <br /> W other than owner) Tithe <br /> FOR M"ARTMHVT USE ONLY <br /> APPLICATION ACCEPTED BYDIVISION OF OF LAND NUMBER DATE <br /> ADDITIONAL COMMENTS DATE i <br /> Final Inspection by: � <br /> }+� I] 24 Date ! <br /> SAN JOAQUIN LOCAL HEALTH DISTPICT acs»en rev ),,>a au t <br />