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f0k OFFICE USE:
<br /> APPLICATION
<br /> OR SANITATION PERMIT
<br /> .,,,.............. ._ (Corriplete in Triplicate) Permit No. .
<br /> .............................. . .. This Permit Expires l Year From baste issued Date. Issued,.
<br /> Application is hereby mare to the San Joaquin Local Health District for a permit to construct and Install the work herein
<br /> described. This application is made in corn
<br /> with County Ordinance No. $49 a d existing Rules and Regulations:
<br /> r �
<br /> s Jt"J8 ADDRESS/L Tl .�. ,", l .
<br /> Owner's me � � ��._� i ...,,. ..,,-_.. TRACT N.........................
<br /> Address VA.. ., `j4`�. ..«w.««...,. ....Phone
<br /> .. ,t. « .. ... ,.,'_ .•.Y«w pity
<br /> Contractor's Name
<br /> License 9Ya .a�7'- ,. Phone
<br /> Installation will serve, 3 Residence 0 Apartment House 0 Commercial oTroiler Court 0
<br /> Motel 171 Other
<br /> Number of living units.-... ..,._. Number of bedrooms .a... Garbc ga-RGrinder .._�°'"`�µLot
<br /> �.Vijcctersupply:,;Pwbiic.Syxt nab xtam .................... ..,,..
<br /> # Char e, .........� � ... _�„.__.. ,.- ,.,Private
<br /> .
<br /> Character of soil to a dept of 3 feet: Sand Silt Clay Peat Q Sandy Loom _ Cloy Loom
<br /> - ,
<br /> r Hardpan j� Adobe E Fill Motaarial..........._ if es
<br /> l (Plot pian, showing siz,6 4 f lot, location of system i relation to wells, buildings, etc, must be placed err reverse side.)
<br /> l MIEN INSTALLATION- (No septic tank or sesperge pit permitted if public sewer is available within 200 feet,!
<br /> PACKAGE TREATMENT f; SEPTIC TANK 4/
<br /> S ....,� . ` ;._.._. Liquid Depth
<br /> C pocity ..f-r Ql ?..w Typ Material. G ► ' ✓ _ No. CompartmentsV V` `V
<br /> stance to nearest: Well ���}..�. «1”«:..—-Foundation ,� ~._.,._, Prop, Line tw
<br /> LEAC HtNG LINE of Lines ' Len th of era line._,.._ '� �
<br /> �. .............. ..._««.w_ Total Length _,........
<br /> YcY:Y Sox .-__ Typal Filter Material , .Depth Filter Material .,f �4
<br /> .... ,�,,.. ,�„. - �,. �•.�..:...r�, 1 ♦ � ,,,, ,�. tea . r
<br /> Distance to nearest: 1N�I �,�+�:_,,.. F � " ' �
<br /> �rrdcrtton Property Line .w ' ,
<br /> SEEPAGE C �ptki
<br /> ..................«. Diameter ._,._w. . .�.. .,�.,,_._............ _....
<br /> f . Number Rock Filled "des [I No �
<br /> nor Table Depth ,.,......«.................«.w.« Size .........................
<br /> Di Lance to nearest: iJVatll ..................
<br /> .............. ....«..,..Foundation .,,...,w,.-,......._ Prop.
<br /> cop. Cine
<br /> REPAIR/ADDITION I1lTIt�N(Prevw nitation Por i. . ,..-..._,...w.-........._... Date ................._..w. ......-
<br /> Septic Tank (Specify Re Wrements) ._. .-,. :._ ..... ......... ., .... ......_.. , .,..,«...«...,«,._....«.-
<br /> Disposal Field (Specify Riquirements) j ,..« ._...._..__ .«....w ......
<br /> .«..
<br /> ........... ,r .. _._.... ..>..mow.,,,„..,,w,. x.«...
<br /> ?r ..._
<br /> ! {Drow existing and'requires-addition on riveters
<br /> t 1 hereby certify that l Eras a prepared this aPplitaifon rialtd that the astsrlc will lei done in actordica»ea with Stas .i,agrsI
<br /> County Ordinances, 5tatel rrwws, and Reales and (Regulations of the Scan Joaquin Local Health District. Kerne owner or licen-
<br /> sed agents signature certifi6s the following:
<br /> =•r certify that in the perfo'rinancer f the work for which this permit Is issued, l shall not ernplzry ilia+! larerss�n in such anner
<br /> as to bee sasb'ect`toxil+l( ma s Casrrriserrs carr vats of calftrolo.YY
<br /> Signed . Owner
<br /> By....
<br /> 1fior�.rsv�,,.. e--- _,..t• .. �'itie ................ .......«,..........,_.-._ _ , _._ .,.__.._...
<br /> tier
<br /> FOR DEPAV USE ONLY =
<br /> APPLICATION ACCEPTED �Y
<br /> BUILDING PERMIT ISSUE �..............w«.._.. ........ DATE
<br /> ADDITIONAL COMMENTS ..-w, _...«.... _...«........_... «..,,..DACE....,..._.-_«.. ................,« .-«
<br /> WincfInspection
<br /> . . .......... ........ .. ._. _.,.,. ... ,_.. ...
<br /> by: ,. , ....,: ....................... .,._,._-.... .. ._ + .._- .,a .i ?.�.«.. ..:. ......
<br /> SAN JOAQUIN LOCAL I-ll, LT I5Tf ICT
<br /> E. H. 9 1-'68 Rev. SNI
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