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r t <br /> 'S".R1T"_9YrhaM1v ,-�wxm ,nr't+.tW r.y,�..,t�.�.eiv.......,........�.._._..__....�......�.vrvw+-+NNGbRllp�gyry��,i <br /> OFFNI`E USE, WE� I , <br /> APPI.ICATH)N FOR SAWATION POLMR 't ` ° <br /> �' ICen►IeNinTripntohl `E�i;;�,�,sr , .! . <br /> ..�..,.. .. .. ... ThOa denote Expires 1 YerxFroee DvN hived -� '•.�. <br /> y.Appy Is herby mode to the San Joaquin Local Health Dittrict for n perm It to ecnslsute OIW e <br /> k , ,dclplEyd, This applkatlen Is modeAn compliance with ^vnty mance No. s49 and <br /> JOB ADDRESS/LOCATION <br /> Nome .... .V.(JE.� ..5(`f1.L.. <br /> +f'& �J PfeoM - i C <br /> Sa4/nf City . <br /> t <br /> ��/t JJ .f`�'// rte) ^�7f-��y <br /> COntraCtor't Name AL„ �l'(1G.l.:.f...(.1�... ......................................LkMM IN pt,l.J.vl..��iTf..... P110ne ..... ....... <br /> -yp <br /> y i ^stailalion will serve, Residence IN Apartment House Comnwrdal❑TmnK Cox! ❑ <br /> ,. i Mold❑Othe,, <br /> Numbs. ofliving units+ ...�.... Number of bedrooms Garbage Grinder�?.. Lot Sete <br /> �a . 1 <br /> soli to a depth of 3 fee�or�dplojlo'be[j <br /> .... Clay.............. <br /> -., Petal .'.:.• <br /> - Wager Supply+ r'ublk System and Home <br /> .. .... <br /> tvoN <br /> r Charoehsr of p y ❑ ❑ .Sandy Loom.❑ Clay Loam❑ <br /> r Plon,.lMwtnpslze of lot, to rolationtowelb, buildings, etc•m� V.t <br /> FIRN16forlal. If , . ....... ....... 4 <br /> IPlot wb <br /> uo be,placed an revere skle) <br /> u NEW iNSiAl1ATIONe JNo septic tank orseepage pit permitted If public seww is available.within 200 fete 1 <br /> J$ ,PACKAGE TREATMENT ( ) ..SEPTIC TANK{ ] Size- ......... ...:.... ........ Liquid Depth .......:. ........ .:.` <br /> 'rr ' Capacity Type .... ...... Material No Compartment, <br /> + Distance to nearest. Well ....................................Foundation Prop. LIM <br /> EACHING LINE ( ] No. of Lines .... Length .,i each IIM ................ ... Total Length <br /> 'D' Box ............. Type Filter Material ... ... ..... ..Depth"Filter Material ................ <br /> +T ; <br /> Distance to nearest, Well .. ......... .... Foundotlon - <br /> 'r: xR , SEEPAGE PIT ( I Depth ......... .. ...... Diameter .... . .. .: . Number .. ... ........ .. .... Rock Filled I .. <br /> Yes ❑ No <br /> Water Table Depth .. .... ... ...................... . ..... .Rcek Stu ............. .................. <br /> . <br /> J <br /> t 't, Dlatance to nearest, Well ................. ......................Foundation . . .. . Pop LIM ..._ <br /> r REPAIVADDITION(Prov. Sanitation Permit¢ ................................. ......... Date .......................... <br /> 1 <br /> ++" &e otic Tank (Specify Requlromonts) . ........... ...................................... ..................._...._....... <br /> ,:.oenol Feld ify Requirements). ....> ��....../y. /.j�fi�......li. ........ <br /> .... ......... ......................... <br /> ..... .. .... ............. ................. .......... ... .. , <br /> tip+ j (Draw existing and reqaired oddlfion an reverq side) � <br /> ' <br /> :ieroby certify.that I have prepared this application and !hot the week will be do" in ecesedarwe with fee 7ettgvle <br /> are <br /> Conry Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner eVlttem <br /> sed agenfs signature certifies the fallowing; <br /> certlfy thof In the performanu of who work for which this permit is Issued, I shall net employ any person in such manner <br /> .' os ,o become sable to�(. kman'ICompensation laws of California." j <br /> l{ <br /> � ..... .. . ......... ...... Owner l <br /> 3y :...:.............. .. .. ....... Title . ..... i, <br /> (If other than owner) ������� � � � _ <br /> FfWDEPARTMENT USE NLY ' <br /> APPLICATION ACCEPTED BY . . ter .....77- <br /> ..........., _ , , ;......... DATE �. <br /> BUILDING PERMIT.ISSUED ............ .,.t ............... .....: ...... .. .... .... ..DATE ........ ... <br /> ADDITIONAL COMMENTS <br /> r. <br /> Finol inspection by //�. 7/� �� _. .. <br /> ............. .... ... .... .... .. . ... Date <br /> X11.13 2t, 1-66 a". 5N [ - SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3114 <br />