|
FOR OFFICE USE:
<br />_
<br />....................... APPLICATION FOR SANITATION PES.........
<br />ES _
<br />..................................................... 4comple►o In Triplicated Permit No....r�''..5.. t�
<br />�.... ................... . .. ............. Tills Peey»it Expires ! Yeeu Fnfnit fhre� IereRwd Date Issuad ..�✓.:.�
<br />+pplication Is hereby made to ",Son Joaquin Local health District for a permit to construct and instafi the work herain
<br />descw3bed. This application is In compliance with, County Ordinance No. $49 and existing Was and Regulations
<br />JOB ADDRES Cid .i�%�./1..! ... ..r.. .�_
<br />. ; .�.l� ��.'..�:....:J......................,...,..CENSUS .. -•
<br />Owner's Narrre.1?° 1w./.t�r« : lr,... .,PhBne:: �`....f..." '
<br />Address ."7" r L �' i` ......... ................. CNy . .........
<br />w ; .,..
<br />+ )' .'..� •�4a� •! L.,ri� /.f_+�3v'.�i.'X..`.Y:................ • ................. a ....+....rw..v..e.w.+.« ».
<br />Contractor's )dame .. _ _ ..Lkefxse i!s Phone ..�.....,.�.,�,..„�,«..
<br />Installation will serve: Residencv,0146&nont House C3 Commercial (3'railer Cenrrt 0 '
<br />a
<br />Motel [j Other ....... Y _
<br />Number of living units:_. Number of bedrooms ...Gprbgt#`1rkl+Nr` ...`c .,lot size ....I.f,¢:..,1(�,,,,., ...
<br />Water Supply: Public System and name _. ! .j ............ .......... ....... _............................ w...................Private
<br />Charactersaf-soil to a depth of 3.feit: I --Sand 0 ,:Silt 0 Gay. C1 _:Peen
<br />Hardpan 0 Adobe 0 Fill A4twlol
<br />11
<br />tpiot plan, showing size oftot, r"On of system in rotation to wells, buildings, etc, must be placed an reverse side;)
<br />NEW WSTALLATIONs tNo septiClztank or seepage Pit permitted if publiP sewer Is available within 200 foot,I
<br />PACKAGE TREATMENT l j" �
<br />SEPTIC TANK, Size.. uid
<br />... .......,,-.....�.....,.. Liq Depth .
<br />t: a ity l�> o.... Type....... _.............. No Camp�a� oments .......�. jj �+.,.....».
<br />Distance to nearests Well ../P.0..� rY
<br />.Ffxrrftf t ._lQ'� `Prttit, t.btia ..�e:: '•y«...»
<br />LEACHING LINE Al No. of limes ................. Lerwh of each flow.
<br />i 'D' Box Type Filter Materialh.,t:pth
<br />�
<br />,.......
<br />Distances to nearest: 1dVel1 ...... Fr�atttdation ... f,(, ........... Prverty lime _. ..` Y�
<br />--iEPAGE PIT { j De th . i _.r 'f .. Number .......A?....... / Rack Filled Yos� Not
<br />'•._-.- ....................... JIM*
<br />��"'
<br />Distance to nearest: Well .... t'1..�Q:.'....... Fel�latlon � Prop, Urur � �
<br />REPAIVADDItHM (Prow. Sanitation Permit # ...._._........................ ' +-` - -:--Date ..............-' ....
<br />Septic Tank (Specify Requirements) --- :............... ........ ....... .......... .1........... )
<br />Disposal Field iSpecify Requirements) ...................... .,................. .....................
<br />j .N,... .............116
<br />. ..
<br />{Draw existing and required addition on roverse �.......,...._........,- ..... .
<br />I hereby eertify that I fwvo earee! ibis a '
<br />Pry . PPfCetlr n ottd that the ww* with b* ems► Irl ottare'Ia o with Sm �n
<br />t ounttr Ordiaonecss, State Laws, and Rules and lilt"lations of the Son Joe uht Loeb no", Dislrlst. momo, owner or hale• r
<br />sod agents signature certifies tier following: A I
<br />"I ramify that ;a the perfonnon to i f iho wont for" which this p►ernnit Is issued, I swl #ret employ any Person in s"h man""
<br />as t0MCVmksubj#A to woArna»'s Carnpensatioif laws of Colitwm&."
<br />Signed ..
<br />.. .... ... ......................_ Owner t
<br />By_........_.............. ...._....<.....,.................._....._...... Sitio
<br />tlf other than ownerl
<br />+WR DiiPAR MELT USE ONLY
<br />APPLICATION ACCEPT 6Y.... ....; . rte. �.. .......,. cr. t. �...__........,. DATE, .. .�!""� _......„
<br />BUILDING PERMIT ISSUED ! DATtc
<br />ADb17lOi�iAl COMMENTS ...... .._.. Lt .......... ..... .................._..._............................................................................_.
<br />_...:..... ..........._...u..i ....................................................................... -.................-----....,��...-._...............
<br />al lnspe....... by:. 1104
<br />..:............. ~....,«...,.................+.....,.................---............. ...,............. .,, ._.._- .......
<br />Et 13 24 1•.68 aev. 5M 1}} ....................................................date p '.�"._.�`...�'r "......
<br />] SAN JOAQUIN LOCAL HEAUH DISTRICT 8/7h 3M
<br />
|