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SAN JOAQUIN LOCAL HEALTH DISTRICT <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />--7?" DATE. <br /> DATE. <br />Final Inspection by: <br />f13 214. 1-68 <br /> Date <br />8/7h 3M <br /> <br />rgaR rOPPILlt 45C1 <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />- _ <br />This Permit Expires 1 Year From Date Pieced <br />Permit No. 7C-9'5'Z) <br />Data Issued .11:795.!4:7726. <br /> <br />OWner's Name ... ....:7,!.-...."Ar.-4-97 -_, I-- <br />A <br /> <br />lfcldress c:::?7 : .,;.<..".".(--, ,,,--'.-j---, city i e,.` .'eve."--o,e„-- <br />COntractor's Name . :7--' license # 2-7‘.V.2 Phone silnstallatiOn will serviell sidence ffj-4ortment Houser] Commercial 0Tralier Court CI <br />Motel 0 Other <br />:Number of living .,linits: Number of bedrooms .2.. Garbage Grinder Lot Size ....... _ .... ........... ...... _ ...... —. — , <br />Water Supply: Public System and name Private fa.--7------ <br />r Hardpan 0 Adobe 0 Fill Material If yes. type - , <br />reverse side.) <br />liquid Depth <br />LEACHING LINE I i No. of Lines 42-5 teltgth-of Total Length <br />SEEPAGE PIT H Number Rock Filled Yes 0 <br /> Rock Size <br />i •6:eipth Diameter ----., <br />r--Water Table Depth <br />Foundation Prop. Line <br />REPAIR/ADDITION (Piev. Sanitation Permit* -,- - Date I . . <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirements) $ <br />(Draw existing and required addition on reverse side) _ i <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances; State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or lice* j <br />sed agents signature certifies the following: <br />"Ccertify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner <br />as, to become sublict to rkman's ompensation laws of California." 1.1 •,, - Signed .... 4._ r <br />If other than owner) <br /> litie <br />Appikation is hereby made to the San Joaquin Local Health District for -a permit to construct and install the work herein <br />described. This application is made In compliance with County Ordinance- No. 549 and existing Rules and Regulations: . <br />.• Ji3 ADDRESS/LOC.:U(0N. -. -p <br /> We- 7 3 <br />CEWSTU-S-TRACT <br />Character of soiya a depth of 3 feet: Sand 0 Silt 0 aay 0 Peat 0 Sandy Loam 0 Colt Loom El <br />(Plot plan, showing size of lot, location olsystent: in relation-to mails, buildings, etc. TriustOms placed on <br />NEW INSTALLATION: (No septic tank oi"-seepagi...pitm4 ifted If ,p'-ubilt-IseZe- ris Civaiialiiithin 200 feet) <br />PACKAGE TREATMENT f ] SEPTIC 'TANK ] Si _ . 1._.... <br /> <br />/ / ; r j Capo4Ity /..2eV, z,e n6 <br /> <br />, '7 .....'r=1P4Tkaterial ' A ,,, / , s 1 DIstan="s7lec .i, V _ --. Foundation <br />i ) B.2): , L •,Type-Filtiii Material . Re Depth Filter <br />Distance to nearest: Well ' oundation Property Line <br />i 'Distance to nearest: Well <br />No. Compartments ... <br /> Prop. Line <br />No <br />By <br />Owner