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FOR OFFICE USE. <br /> ......................................:J.�.`.:.3�', . APPLICATION FOR SANITATION PERMIT <br /> v.... .............................. (Complete 1n Trlplicatel. - Permit,No.•'` 6 az/.3 <br /> ........................... <br /> ... __- �.This>serrrtlt IiExpires 1 Ysar Prom Dote issued. date Issued .,a a`...7� <br /> Application Is herebmade to the San Joaquin local Health District for -a permit`to cwnnstruct and Install the work herein <br /> described. This appl€cation is-made in compliance with County Ordinance No. 5,49 and existing Rules and Regulationsr <br /> JOS ADDRESSAOCATION4 7�6 .- # ; <br /> .....CENSW TRACT ..... .... . <br /> Owners Name ... ..0 wise. . ......`..............:`... .. .. 4. ....... �aI(o �.. a <br /> .� ,. .. .Phone .`1 .. ........................ <br /> Address :C (,�., .. # r <br /> € i .... • i ,City_. <br /> Contractor`s'Name .... ... . ........:......License ; .` . . Phone <br /> Installation will serve: Residence O..Apartment-Hoarse ] <br /> 11 ' W . :. - , .Commerdurtal I]Tra}ler Co <br /> t Mom Q'4ther ` y <br /> Number of 1i�ing Lunita: s. Nwnber"of-bworft `::: Garbo a Grinder .......: # Lot Sips ... . <br /> Water i6pply: Public System`a ,. l� ,.•... <br /> nd name .:.... .......... . . <br /> ' Character of Boit to a depth of 3-�feefi Sand Silt Q Clay,❑` --Paan- `[- v /{�j.�.�.....y..,/..� <br /> ;Hardpan 0 . Adobe ~ fill IIAMatetlal .. ...•.•. ff re%type <br /> . . .............. ............ <br /> #Plot plan, showin slis r - g <br /> #� 9 of lob-location-of system In-relation towwells;-buildings, etc,[ ' be,placed on revere dde.1 <br /> NEW INSTALLATION: <br /> (No septic tank or seepage pit perrmWed N public sewer is available wNltin 2W[ej <br /> PACK AGE TREATMENT I I UPTIC TANK" . ....:. , <br /> •..». •.l Liquid l7epth •..• M <br /> eapar}sy ..:... Type ...: .... .... . . hto. 'Cotnparttnem ... <br /> T.N»......NY. <br /> .. •.• ..,•• .. .• <br /> I Distance to nearest: Well ...,». .•.. . :.....•.....Foundation , <br /> LEACHING IiNE _ I I Na:of Litres .:.....: .. : ungth•of`srtch Ihae. e• ::. .... <br /> LW <br /> V Bax t...:_ Type filter Material •Depth Filter MataNd .....................» G ' <br /> . t7 Distance to necnri0;°.Well ... ................ Fisundation ...1 ! , Y •.. <br /> ._ .. <br /> SEEPAGE PIT j } pepth .. Diarnetec Nun�er f. ................ <br /> -.. "-_ I .. ..... •. .. A Filled Year 0 fro+C] 01 <br /> Water Tablo Depth .............. ................ Rods S1se . ........ ........... . <br /> ...... <br /> . Distance to nearest, Well , .... ...Foutndgtion ... ...... . . Prop. '!Me <br /> REPAIR/At�DITION(Prov. Sanitation Permit # ;. ,`. .. •.••.•.,.Y„•..}». <br /> ,..... . .. .......• Doh d <br /> so <br /> pticTants #Specify Recjuirementsl ...:.�... ........... t �'}.�--.� .=.._ : <br /> € i ........................................ ............................... Y...... <br /> Disposal'Fkld #Spacify Requirements) ....... ... . --.. ....... F ... ... . <br /> ....._. ... .. . : .: _. r. . ......... .,. <br /> ' #Draw existing and required addition on reverse andel —�. ti - .. . . <br /> 1 :hereby tart}fy that I have prepared this application and that the work1will be 44o }n acsordcwft wlllsiips . <br /> County Ordinances; State Laws, and Rules and Regulations of the San Joaqutrs Local'Htaphh-Dlstrtp.Herne owner or lkat� j <br /> sed agents signature certifies the following: f <br /> "I certify that in the performance of the work for which this ' <br /> permit b issued, 1 shall net enrptay rkmanany petrtew <br /> as'to became sob1 . � suds ass�ser <br /> act to Wo 's Compensation haws of California.” <br /> --- _ .-.-. , <br /> 5ig , <br /> nod .............. ......... .. <br /> ------••..............••---• Owner : <br /> By ............. '.. ..... T€tie _.... '. <br /> (if than owner! 4.. i <br /> FOR DEPARTMENT USE 4NLY <br /> ,. <br /> APPLICATION AC EPTED BY <br /> BUILDING PERMIT ISSUED ................... ............................ <br /> Ai7bITIONAL COM 5 . ..... -• . <br /> -------- ------ .�. - • <br /> ......_.....---.....-,....- <br /> ...:._.:. .......................................... <br /> .......: <br /> .....•---•.......... <br /> t^inai Inspection by: ........._I.......................... .. <br /> r • <br /> .. .Date .: d- <br /> � �.3 2!i �.-6 i3 . .. .. ... <br /> JOAQuIN LOCAL HEALTH DISTRICT /7 PM <br />