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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .
<br /> ----------------------------- Permit No. - -----------------
<br /> (Complete in Teipliia
<br /> ----------------------------------------------
<br /> al Date Issued
<br /> jTkii Permit Expires I Year from5,qat��� --- --------- -i;;o
<br /> ----------------------------------------- ----- ---------
<br /> J'
<br /> Application is hereby made to the Son Joaquin Local Health District fora permit,403'co stlru�tirahwork herein
<br /> application
<br /> instaII4
<br /> "
<br /> described. This ap 1, t, n us_made in cam ince with CoOnty Qrdjnan�e No',,;54 and exisf Ing-�OlesiYh&Regulations:
<br /> JOB -
<br /> A OV-2f /�k S—
<br /> AME F 5/LOCATION.C A T 10 N-� .......h.
<br /> ----------------------------------------------- ---I--------------- --------CENSUSJIZACT ----------
<br /> Owner's Name X
<br /> -- ------------- -----------------------------------------
<br /> ----------- ---------<��- Ph one
<br /> - �771------------------
<br /> Address 'City
<br /> ,--Co ----------------I----------------------11 ------ W._---
<br /> Contractor's
<br /> ntractor's Name ----------- 4----------------------------------- -'-dicense 4�--PZJ-e---- Phone
<br /> Installation will serve., Residence - partment HouseE] Comm.ercial :E]Trailer Couirt''.'o
<br /> Motei.D'Other -------------- -----------------=----------- ri' /
<br /> Number
<br /> ---------------- -----------
<br /> Number of living units:_-__ ...... Number df.bedrooms -%3------Garba6e�Grincler LoVSize ------771Z--------------------- -------
<br /> � , f, --------
<br /> Water Supply: Public System and name ---r �711'Z;/ N � 9'e.
<br /> ---------------------------------------------------------------------------------------------- --------Private
<br /> - V�
<br /> rdept El Sandy, Loa'N,,E] Clay,Loam E]
<br /> Character of soil to a depth of 3 feet-. lay
<br /> San' 1:� I ",J,
<br /> Hardp'64� -7(V- .-' If-yes, 4.
<br /> Fill M�fFe,'ial 0 -
<br /> El' p F
<br /> 1.1. -
<br /> {plot; 41`1/
<br /> ,plan, showing size of lot, location of,�rsystem in relation to wells, `"
<br /> buildings, etc. mpt4be placed on reverse side.)
<br /> tank orf permitted I py .1c sewerisa
<br /> pa e pi perrr 14 within 200 feet,)NEW INSTALLATION, (No septic d 61* vailabl w
<br /> PACKAGE TREATMENT [ I SEPTICTANKf, - Sizel? 'r ---------------------
<br /> ,F ---!,-' Depth
<br /> q yr,'!Compartments
<br /> —C M
<br /> RAcitwIQ :Z:,,,� Type/017-731f - dteria40�"-Zr No./!Compartments --------
<br /> 7—
<br /> Distance to neard.st.,!Welf -------------- Foundation -------- Prop. Line 7
<br /> , r .l--------
<br /> J ----------
<br /> LEACHING LINE 4��jNo. of Lines Length of eaCA he ---fTotal Length -----19to-M
<br /> I a
<br /> 'D' Box Y Timpe-14f-ilte'-V terial Depth Filter Matf'�ridl ----------- -----------------------
<br /> 006.
<br /> dation ----------- 'Property •Line --------------
<br /> -----Distance to nearest: --- Foun
<br /> SEEPAGE PIT Depth ---------------�A FMI'7 -- -r-'-Nu�nber
<br /> --------- 1�/,kock Filled Yes E) No 0
<br /> Water Table Depth r
<br /> `Rock-s", --------------
<br /> I N4i
<br /> Distance to nearest: Well ----- -----------------7' --Founclation ---------------z---- Prop. Line -----------------
<br /> REPAIR/ADDITION(Prev. Sanitation Permit#I-------- ----------- ------- '_.g' al'e ----------------------------------
<br /> Septic Tank (Specify Requirements) ---- - '
<br /> ..
<br /> -----------------------------------------(j-
<br /> ---------------------------------------------------------------
<br /> -------------
<br /> Disposal _Field (Specify Requirements) ---------------------------------- ,-,73-—-------------------------------------------------------------------- ---------------
<br /> ---------------------------------------
<br /> ---------- -------
<br /> - -t - ---i---------------------------------------------------------------------------------I------------------------
<br /> -------F-t9 *#7
<br /> --------- -- - -------------------------7 ----------I/---------- ---------------------------
<br /> -------------------------------- ---------- ----------------
<br /> (D(,ci.w xistirtg and-required additlon'pn reverse-side).
<br /> I
<br /> everse-side)—
<br /> I hereby certify that I hcvW,pi4o&W [this application and that the work will be done in accordance with San Joaquin
<br /> County Ordinances, State LG)", and Rules and Regulations of the San Joaquin Local Health District.' Home owner or licen-
<br /> sed agents signature certifies the following:
<br /> "I certify that in the performance of the work for which this permit is issued,,I,shall not e 'ploy any person in such manner
<br /> as to become subject to Workman's Compensation laws of California."
<br /> Signed
<br /> -------- ------------- --------�-7-- -:Owner
<br /> By -------- ---- --------------- ------------- ----------------- Title OL-�!e ------------------- A
<br /> (if other than oww
<br /> - FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY --T-,RtV-------------- ----------------------------- -------------------- DATE --r'----•---
<br /> ----------
<br /> BUILDING PERMIT ISSUED ----------------------------k-------------------------------------------------------------------------, -DATE -- ---- ------- --- ------------------------ ---I-
<br /> ------ --- ----------------------------------------------------------------------------------------------------
<br /> -------------------
<br /> ------------------------
<br /> ----
<br /> ADDITIONAL
<br /> COMMENTS ---
<br /> ` DISTRACT
<br /> ------- --------
<br /> -�-
<br /> A
<br /> ------------ - ----------------------------------------------------
<br /> ----------------------------
<br /> ----------------------------------- ---------- - ------- ----- -- -- -----------------------------------------------------------------------------------------------
<br /> ------------- -�----------------
<br /> -- - ---'-----'-------
<br /> -----------
<br /> Final inspeCiio - - ,Dater r.-- -- - ---- - G -------
<br /> SAN JOAQUIN LOCAL HEAL�HDISTR
<br /> E. H Rev.
<br /> 5M
<br />
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