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>=0R 4FFI .9 USE: y Permit o <br /> ApPLICATIi4N FOR SA.NIT�ITION. PERMIT ,� p it N . 7 <br /> ................... -------- � __ (complete in Triplicate) _ ` 3� 74 <br /> r <br /> i <br /> -Dat lssu <br /> 1V This PermWExpires Y6or FronrDahtlssu <br /> .......::......................................... .... i ` - <br /> w i <br /> and' <br /> A iicatiomis--hereby made to t6SonJoaquin Loco! He Cal DistrictyOinarnce No. 549 and exismit to ting g Ruiestand Regulations:sin <br /> Pig . fiance with Y <br /> described.This application is made in comp �Gip,i��t7 x <br /> _ ..CENSU TRACT .... <br /> mea....._ '` <br /> JOB ADDRESSAOCATION .._... .....,.... f ......:_. ... .. .......... <br /> Owner's Name ..._f .,...... <br /> f� ' .. = �. Phoria s �.7.Q.�1 <br /> ." City .�?' / �?..tT!:1��........ c3f ' <br /> Address ........... � ._... ._....ES r. s..., fi icense # . .7-3. Phone. ......- <br /> Contractor's Name martial[(Troller Court <br /> installation will serve: Residence[3 apartment Hausefl Cam ;.�.,. <br /> -.�-. <br /> Motel�;Oth ...:..... . ......... � <br /> ^�Ga"rtia a Grinder Lot Size <br /> f�.. Number of bedrooms .._......--- <br /> g <br /> Number of living units--./V.. v <br /> 6 °=� y ............... <br /> :. ............................... <br /> Private <br /> Water Supply: Public System and name .................................Cla 1 ❑ <br /> + Peat Sandy Loam 0 Clay�^"o f <br /> Character of soil to a depth-of 3 feet: Sand [] <br /> Silt Q k Yom" .............` . <br /> ``-.Hardpan 0 ' Adobe Fill Wal_ ial if yes,type ...... <br /> � f � b <br /> win size of sot, location of system in relationta,wells,_buildings, etc. rttivat be placed on ireverse side.) <br /> (Plot plan, showing <br /> NEW INSTALLATION: (No septic tank or seepage pit laermitted If public sewer is available within 208�fye�et,[ } <br /> k * t� ... �p�h ...... <br /> SEPTIC TANK{ ] 8ixe......- •- Ll u <br /> PACKAGE TREATMENT [ ] l No. Compartments ....................... <br /> C city4 TYpe' '' `:Materia. = ...........� <br /> Foundation '---=Prat Line <br /> _ <br /> Distance.to nearest: Well ....---......... .� . <br /> Ad <br /> Total., Len9t . <br /> No. of Lines '.. ` Length, of each line...------... <br /> LEACHING LINE [ ] <br /> t -�` ^�rQe th filter Materia ..................... <br /> k .... . <br /> 'b' Box ....-.._.. Type Filter Material.:..-r---.....---•-- P ,.. <br /> '''} ' Foundation --.. ........ ... Pro erty L e <br /> Distance to nearest: Well ....-•.--------•----•-•. <br /> In <br /> i \ ` <br /> r ... hock Filled Yes ,"-'- <br /> ------ O7 <br /> - ...--. Diameter ----, Number .... _ <br /> SEEPAGE PIT Depth - `' Jy, V- N .,.� x....... <br /> --------r 1 1"" ...... `Rock Size .-�— <br /> Water :Table Depth 9r --- <br /> p .t <br /> .--.•_..Foundation ._..:: --= Prop. Line � ?y <br /> Distance to nearest: Well ......,/�� �7..----, - .�' <br /> REPAIR/ADDITION(Prev. Sanitation Permit�` _............. --• Date_ ....---•-- .... <br /> -- -� Iii ....... ..... ......--••---•-- <br /> Septic Tank (Specify Requirements) ----------•-•-••• .................. <br /> :.' . <br /> Disposal Field (Specify Requirements) ------- ..............f- <br /> , <br /> ---••------------------ ------- -. ----••---•--• ........................... - -------•-•- . - <br /> ..... .__.......F-:dam .. ........... <br /> i ------- ------------------------- ..------(Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application dnd that Elie work will 'be dans in astordanu with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San JoaquinLacal Health:District. Home owner or ticen- <br /> sed agents signature certifies the following: arson in such manner <br /> "I certify that in the performance of the work far which this permit is issued,:! shall not employ any p <br /> as to become subject to Workman's Compensation laws of California.'f : <br /> L. <br /> Signed � /1�1. _ tSG� .4s4wner - --- <br /> i. . I <br /> I <br /> BY <br /> # ......'..__. Title <br /> (if other than ovrner) <br /> FOR DEPARTMfN'_USE_.ONLY <br /> t r <br /> � - --••-•- •-•--------y=------------------•--.... 3..�7. ...--••----•- <br /> APPLICATION ACCEPTED BY _ . .. . ----- •------ " <br /> _ _ DATE .----._..._._....---......--•--- ---...-- <br /> BUILDING PERMIT ISSUED .-_.. - � .. � �...._; .._`...' ................................_......._........ <br /> ADDITIONAL COMMENTS :_ _- ....................... 1-,..a t , <br /> --;�'r ............... --------------------------- <br /> ------------------- <br /> . .. ........ <br /> I� � . ............... <br /> Final Inspection by: --------- _........................... ..... ... <br /> Date . ......_... <br /> EH 13 .24 1-68 Rev. jH SAN JOAQUIN LOCAL HEALTH DISTRICT $��� 3H <br />