|
Z .` t
<br /> FOR OFFICE USE
<br /> APP .,CA"TION FOR SANITATIO *PERMIT
<br /> 7.3 �t,a
<br /> i
<br /> (Complete in Triplicate) i
<br /> 4 -3
<br /> Date Issued .:...................a
<br /> This Permit.Expires 1 Year From Date issued
<br /> Application, is herei;y r-u,de to the San"•loctquin-Locolliealth District for a permit to construct olid install the work herein*,
<br /> 'described. This applicotion its made in compliance with County Ordinance No. 549 and existing Rules and Regulations, ;
<br /> ;.tots 1J d r? r CENSUS TRACT ...................a:...
<br /> Owner's t Lame �r ..................
<br /> :.
<br /> ' 1� ',1-r.E�.. .... ._......... Phone ,
<br /> Ac{fires. (�.�� �� s { -_ 7�/�S City .. rc• --•95..a,.z 1
<br /> .:1 ........... .. ../..... ....-- -
<br /> Conlrcx.lnr's f,1c rr,e License Phone ..
<br /> ,Inslollotion will srrve: Residence [ 1 Apartment house Q Com6.vrcic [jTrailer Court ❑
<br /> Motel rj Other
<br /> t•rumbpr of li•;inct units: t-Iumher of hedrooms Gnrhoge Grinder tot Sixe .. . ..... ..:....................
<br /> ......'
<br /> [�Woler Sur,,^Iy: 4'vl:lir Sy-,tem unci name .......... . .....:.. .. . - ..:._. ..................... .....,..............Private [�
<br /> Chormter of soil to o dcplh of 3 feel: Sand [_) Silt ❑ Clay (] Peat (] 5ancly Loarn [) Clay Loam ❑
<br /> liardpon y'' Aclobe (] Fill Material If yes, type . . .... :. ...-. .. l
<br /> (Plot nl(in, shov,ina sue of ;at, location of system in relation.to wells, buildings, etc. must be placed on reverse side.),
<br /> NEW INSTALLATION: rNo seplic tank or seepage pit permitted if public sewer is avai3abie within 200 feet,}
<br /> Size PACLiquid Depth......... ....:_.:..::. ..:.;�
<br /> ' " Y.AGE TREATI•,1Et�1T � 1 SEPTIC TANK .-._..- L;q p
<br /> Capacity Type ..................... Micellar. ..,:.. ..,._ . ::_ No. Compartments
<br /> .....................
<br /> ' Distance to ncares.l: Well . ......... . ._.......... .......Foundation ....... Prop. Line ................
<br /> LEACHING LIP-IF i ) Ho. of Lines ,Length of each line ... Total Length `s
<br /> D" Box Type Filter Material ...... ........... .Depth Filter Materiol. .
<br /> [Ys!ancc: to ncurr_st: V'lell .. . .................. Foundation ... ".. Property Line ........: . .
<br /> SEEPAGE Pl3 ; (terfla Diameter ... Rock Filled Yes ❑ No C ,
<br /> :','oter Table Depth .........Rock Size
<br /> oundatian ..,.
<br /> L;istc�nce to nnprE''9.t: 1�ynll. :,. ... �:. ........... ..... F ... ... . � Prop Line ....................
<br /> REPAIR/ADDITION IPiev. Sanitotion.Permit — .. ..... ... .............. ...... ... Date . ................................
<br /> )
<br /> Septic Tank {Specify F.na°uirements)
<br /> D;sposaf Ficicl !Srr,cifv Requirements]
<br /> l vr7� —! 1_9.���- �r �/:__.?�t�._ /(Yt.r /r r✓ .�i_1_�"rt�r 1.flT.lrti ...�.�..Y.r
<br /> X.`..�
<br /> r
<br /> c,:v rrist'99 and requiredaddition on retiierse side[ C-_C?'r�—r_e- �-a-
<br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin
<br /> 'County Ordinnr,cps. Laws, and Rubs and !Regulations of the San Joaquin Local Heallh District. Home owner or licen-
<br /> sed ogents 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-1
<br /> as to become subject to Workman's Compensation laws of California."
<br /> Owner _ J
<br /> Y Title
<br /> W other than o'rrner) J
<br /> FOR _-F, .,.iVAENT USE ONLY
<br /> APPLicn.Tlpf1 ACCEf'iED e %�....... • ........... ...... ...-... DATE 1j�C�,2 D..-.7„3........._..._.
<br /> QUiI.DI,'1IG PErr:;,lr ISSUED ..... ........................ ...........................................................................DATE .... ......... .........................
<br /> ,ADDITIONAL COMVkE,iNTS . ..... _ ............. :...,,.._:..__...........
<br /> 4 ,}
<br /> ................
<br /> . �.�-a1- ..... ..... ............,...,..._.... . ....
<br /> ,Final I:nshection by: /.i"�s="}"Lx.Z.P,r.d ...Datelj� r.Z. ....
<br /> SAN JOAQUIN LOCAs: HEALTH DISTRICT
<br /> v� .
<br />
|