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a,- is w <br /> FOR OFFICE USE: <br /> -Q� ,� APPLICA <br /> . ........ MR SANITATION PERMIT <br /> ........... ...w................ Mom*Plete in Triplicate) Permit No. <br /> ................... This-Pan-nit Expires 1,Year From Date Issued <br /> oil Date issued <br /> Application is hereby made to th6,Som Joaquin local Health 'District for 0 permit to construct and inste'll the work herein <br /> described, This application is ri-tcWe in compliance with <br /> 1. 1 County Ordinance No. 549 and existing Rules and Regulations.. <br /> L JOB ADDRiESS/LOCA I 1&SZ;7 <br /> ............. <br /> i ...CENSUS S TRACT �S_,5z, <br /> Owner's Nowt 0­:t.,..-.,I- ...... .. ....... <br /> ........ .._...._Phone 4_5�1.57 ...... .......................... <br /> City <br /> Address ........ <br /> Contrxictor's Name <br /> .......... .............. <br /> .............. ---------- <br /> .........License # ...........7............ phone ......... <br /> Installation wi 11 serve: RlesidenceApartivientl­li <br /> Ouse 0 Commercial OTroiler Court <br /> Motel C3 other <br /> Number of living units...)...... .Number ofbodrom' s Garbage GrinderWater Lot.Size ... j 9= <br /> mjy Public System attriami . . ......_::t:­........... <br /> Character of soil t Private <br /> to depth of'3 feet. Sand Slit 0 ........................................... <br /> CIGY 0 0 Sandy Loom 0 Clay Loom �-� <br /> • Hardpan Adobe-Cj FIIJ Materjoj..!k <br /> If yes,type....... <br /> size(Plot Plan, showin-g, j�e of lot lo.cation of ..................... <br /> . system in. elation etc. must be Placed on reverse side.) <br /> NEW INSTALLAT1QN.:-, 'RNo septic tank or see age Pit-permitted If public sewer I <br /> PACKAGE TREAT P 3 available within 200 feet,) <br /> SMIC TANK; Size—.....-1..........................a.-it;*J.- Liquid *_-I-------- ...... <br /> Capacity il <br /> ---__1....... --- Type ---_*............... Material..i y . Co: <br /> Distance to, ...... Compartments <br /> rtments ................—.6 <br /> 4 - i neares�.- Well .......Foundation LEACHING LiNg ... ............... Prop. Llne'.t........ 41 <br /> No. Of Lines <br /> ........... Length of each tine._.._._--.... .. <br /> D, TY l is filter Material Total Length ....!............. <br /> ..............�Depth Filter <br /> rial ....... <br /> Dktanc!j to nearest,�-Well-------j ......... <br /> (A <br /> Foundation .......... <br /> SEEPAGE 7 Prop" line ...................... <br /> _Depth Diorneter <br /> ................ Number <br /> Dept ...... .... ..... Rock Filled Yes NO C) <br /> Water Table De Q-5 <br /> t�.......... <br /> 41 1........I........m-­......Rock Size <br /> Distdnce-to.neares, ell :------ <br /> ................... <br /> Prop. Line ......... <br /> . ............. <br /> REPAIR/ADDITION-,(f rev�-;Sonj'tati Date ...a"I" ............ <br /> Septic'Tan:_ <br /> ank ISPecify �4 .............. ----------- <br /> ----------------­-- <br /> fti7 <br /> ................ <br /> Dispcsol Field (Sperif m4ents) ...jalqx <br /> -y Require. ......7­­­.... <br /> ... ........ <br /> ...... .. <br /> ......... <br /> C <br /> . .......... .. .. ... <br /> ................ <br /> a_ <br /> (Draw existing and reqoIred ..I....... . <br /> I hereby certify that ) havo-prepared this; application and "" addition art reverse side) ................ ... ............... . <br /> that-ths Work will he done In *41961dilfice with Son Joaquin <br /> County Ordinances, State,t7t1W1;-&A81"u of W—d-Itft-ulatlens of <br /> sod agents signature cortifi,os".following, the San -to"- via Local Health District. Home owner or licen. <br /> certify that In the perfonnanft:c'• <br /> Wcwikfar which thit permit is Jos <br /> as t b t4#5 CC of i U" <br /> Vsubjed Uwor mpenocition laws of California." 1 shall not OmP'*y any Person 10 such manner <br /> Signed <br /> -rl'�FM <br /> .........;............ <br /> ... .......... Owner....................... <br /> ......... L_LF-:V 1) <br /> .............. ..... ..............Title......... _..�X' FF I <br /> (if other" ...... . <br /> ./A( �J <br /> FOR DEPARTmENT•ZSE ONLY F1'j'q'__ �th?-&P-b <br /> APPLICATION:ACCEPTED 13Y......T _7=77777=�:ii: 7-F-D <br /> allILDING PERMIT ISSUED ------- --------- ......................I—-..... f>ATE.... <br /> ADDITIONAL COMMENTS ...... ----------­'­------------------­--...................... ..............DATE .... . <br /> .. .. . ......... .... .. ............... <br /> ......................... �L--- ------ - ........ ......... <br /> -z .......................... ............. <br /> ...F4 ........................................ .................Inspejctfo <br /> . . . .. ... ................. <br /> ------------------— <br /> SAN JOAQVIN LOCAL' HEALTH DISTRICT <br /> E H.13'241: <br />