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r _.FO�,GFFICI USEt�.. Q�,F1C I1 Sr` 1�3 i" omSl= � �� .z _
<br /> APPLICATION I 1 SANITATION PERMIcon, In Triphcatei n: _ Permit NA. ..0
<br /> ... .... ...............
<br /> ................... . This Permit Expires t Year From Datstswed i
<br /> Application is hereby made o the San Joaquin Tocol Health District for a permit to croshVd and install the work bereltt
<br /> described. This'applicotion s made in compliance with County Ordinance No. 549 and existing Rules and lletgutotlo"
<br /> jOB ADDRESS/LOCATION ..-•& -----..._. . / j` 491L:!��,� ��',�=4�
<br /> _ AI_---��� ..CENSUS TRACT '.lL..:......:....�,_...:,:
<br /> Owner's Name .. ,/P � ..- ...a�i L1�S„S e . . . ....... . a .......
<br /> Phone ,rT .+ ►� ,.;,..
<br /> Address eZz_:7�..s��t���—�-//�,�'. �� ....................... .Citty
<br /> Contractor's Name ....SA-14 ...A-..... z ... ..._. ,_ Phdne ...... ;
<br /> Installation will serve: Residence WApartment"ouse Q Cornmesclal OTrailer CQitn-E3—
<br /> Motel []Other.
<br /> Number of living units:...;.-- Number of bedrooms ......Garb"D Csrindcr Lot Sine ..110.4—.y.45..�„--,.--
<br /> Wgter Supply: Public System and name -4. v.—rfo -.... Ilk
<br /> Character of soil to a depth of 3 feet: Sand E] Slit 0 Gay 0 Pei#a Sml.aatn ig Gay Umm t3
<br /> Hardpan(] Adobe/r�� dill Moate f
<br /> .. .i '�+ Y.T.,1'!l.TT 1_ ynI .............. .\-L=TTIiT,.
<br /> {Plot plan, showing size of ilot, location of system in relation to wells, buiiA49s, etc, miist,,bo placed on re4rlers4 00 �
<br /> iNE1r}€EidSTALLAT10Ns (No*septic tank or seepage pit p+c mlftd Ify—wk sewer is available within 200 feet,}
<br /> Liquid petit
<br /> PACKAGE TREATMENT f.]--SEPTIC TANK� ] Mize �!�'�1?a':.L��3f
<br /> ,._ L
<br /> Cdpacity T MaroW.f�, Alcr, C¢Enparttn , - '�
<br /> i Dist rice. to nearest: Well ,,�',� . ..LLL{ atiiaa,..�12 . e Prop. diner 24, '�T
<br /> LEACHING LINE ( ] No.:of Lines ...3................. Length of each Pirie,.. . ..,.... TotalLength �`? ?.............
<br /> W`Box X4 5. Type Filter Material lIII'a inial ...1 . ....'. ....
<br /> Distance to nearest; Well ....6Q.Q._..... Foundatim. ..-.. Q............. Property Line! . .67.,
<br /> SEEPAGE PIT ( ) Depth ...............6.... Diameter ................ Ntimber _,.... ..
<br /> --. -_--............- Rock trilled Yes � Q
<br /> Mater Table I]epth .lam Size
<br /> Distance to nearest: Well ..._..._...... .. . - .-=Fawt thm . ..:....... Prop, hkie ... ,......--........__-
<br /> 'REPAIR/ADDITION(Prev. Sanitation Permit# ......... ............. ., Pulte _...,_ . ....: ,.... .I
<br /> Septic Tank (Specify Requirements) ..... -----••--• -• . .. ........:. .....:........... ......................,.
<br /> Disposal Field (Specify Reiquirementsl .............................:: .. . ........ . ........ ......... .. ..............': ... .................
<br /> •
<br /> .............................................------------- ------ .................................... ......................................... ... ..... ..
<br /> {Draw existing and required"addition on tevarset side]
<br /> I hereby certify that 1 have prepared this application and-that'" arca vrlti be dobe In accordance with Sine julwe
<br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Heaith:Dlstdcl. Ham* maw or Ran-
<br /> sed
<br /> seed agents signature certifies the following:
<br /> "I certify that in the performance of the work for which this permit Is issued. I daR teat employ any person,In such marew
<br /> as to become ublect to Workman's Compensation laws of CaliTamlo”
<br /> Signed _}_ .. ,. .............................. Owner
<br /> By ----------------------------------------------------------- ----------------------------------------- Title ..........................................................................
<br /> ilf other than owner)
<br /> 4 FOR ARTMENT USI ONLY
<br /> APPLICATION ACCEPTED BY - %.- .. :...� ........... DATE .......... :.,ld''. .:
<br /> BUILDING PERMIT. ISSUED ......DATE ........ ..............................
<br /> .......... ........
<br /> ADDITION ALBCOMMENTS ................. ------------------- ....... ......,................................. ...........I...............
<br /> ..
<br /> -------------- -------•-- ..........................•--------------------------------------......... .-..- ..........................................................
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<br /> ---------------- -------- .
<br /> y ----
<br /> ........-•.......................•...-.........
<br /> 1.-.. ..................
<br /> Final Inspection - _ 3
<br /> ......................•-•--------------------•-------_.. .........-Date ..... ...-.....--
<br /> EH 13 24 1-4V• 5M SAN JOAOUIN LOCAL HEALTH DISTRICT 8/7h 3M
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