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FO, OP,,...E USE <br /> r:?? APPLICATION FOR SANITATIOMrEWIT <br /> (•:omplefe Permit No.iL in Triplicate; ' <br /> ih;r_Permit Expires 1 Year From Dote Issued <br /> Dat(- Issued <br /> " Appl,--i,:cn isherN y n,a� r <br /> -Ie San Jca-i Lc:c;i Heai:n D strut "Cr :: oe,rnit to construct and install the work herein <br /> des- ' ?d. This app.licn,:on is^mode in cor•r.';cr,__ ui'h Ccunty Cr-I nCnce No. 5:9 .and exist;ng Pules and Regulations: <br /> ,.� JCS ADDP,:ES'LOCATION Y C, CENSUS TF_AC .. ......- <br /> C , �� <br /> J <br /> ;T Owner$ Na1Tte. t .,_• ! - �... Phone ... ---... <br /> Address `rty <br /> Contrcctoi s Name �.��- .+� � �•-� ��� f" t License #. /f'l y!�" Phone <br /> _ .._._.... <br /> Installation will serve: Residerc,: %"'tFortment Hou<e` Commerr:al +iTroiler Court <br /> r Voll; ,Cther <br /> Number of living units- ' Numbtr of bedrooms s Garbage Grin2er Y�3 let `_'ire ...... <br /> Water Supply: Pu iic Sy:tem and nom^ P,-;vote <br /> Chcr-wer of soil to a depth of 3 feet Strnd t_ Silt j_j Clay Feat Sandy Loar, Lj Clri I --t 7 <br /> Hardpan,_/ Adobe r-- Fill Mwerial If yes,type <br /> (Plot plar., :bowing size of lol, location of system in relation to wells, buildings, etc. m isT be placed on reverse sir? <br /> NEW INSTALLATION: (No tank or seepage pit perm::ted if public $ewer is available within 200 feet,) ~ <br /> PACKAGE TREATMENT SEPTIC TANK 7 1 Size Liquid Depth . <br /> :oPacity Type Material No. Corr.part.-nents <br /> q" <br /> Distance to nearest: `✓tell ra mdntior. Prop. Line <br /> LEACHING LINE f I No. of Linos Length of each line Total Length - '-.........- -.- <br /> D Sox Type Filter Material I Dewh Filter Ma.?r:al <br /> D dance to nearest: Well Foundation Property Line <br /> SEEPAGE PIT Depth Diameter Numbe- Rock Filled Yes No L <br /> J'ater Table Depth _ Rock Size _ <br /> Distance to nearest: V.'ell __Foundation Prop. Line .... ............... <br /> y' REPAIR/ADDITION(Prev. Sanitation Permit# Date <br /> Septic Tan!; (Specify Requirea,ents+ <br /> 4 0isposol Field ,Specify Pe,�u,eT_ents) �...-s�r�:� <br /> �C t-/.� _;�..y�(. c L�..� t i Z.0 [ �c: :•'Cv.w� U /<<�t�./C ��- L-:_ <br /> D. ex.:tQ;)and required addition on reverse side) <br /> I hereby certify that I have prepe.ed th's application a,sd that the work will be done in a:cordance with San Joaquin <br /> County Ordinances, State Laws, and Rues and Regulations of the San Joaquin Local Hea!th District. Home cwner or licen- <br /> sed agents signature certifies the followi ig: <br /> "I certify that in the performance of tho work fo• which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Cc,rpensation laws of California.•' <br /> Signed I.a; Owner <br /> ate.,Y <br /> 1...._ <br /> W whet tiro^ ��me i t <br /> .4 <br /> FOR DEFORTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .;�' �i%.� � DATE <br /> .. BUILDING PER ..!T ISSUED DATE <br /> :,GDiT!C)!, CG:4!.SEt:TS <br /> ..° F,no; trsceG c cy: <br /> : S:•,. �L'.'. 1.0--AL N::,L H DISTRICT <br /> ,t <br /> i <br /> r ' <br /> i <br />