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<br /> `{ 1 FOR OFFICE USE, d
<br /> .............. 13.0 APPLICATION FOR SANITATION PERMIT
<br /> l a � (Cempleh In Trlr.licatel Permit No 'd rf�C yt#r
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<br /> 9 This Permit Expires i Year From Date laucd Date issued !.
<br /> Applioojion
<br /> Is htroby made to the San Joaquin Local Health District for a permit to construct.and install the work herein `
<br /> 1 datbtyd.Thls.application is mode In comp^lion with County Ordinance No. 549 and existing Rules and Regulations: ;,, '
<br /> JOB ADDRESS/LOCATION Z�l..l}� /*-.1.. i ', rf✓...,r.t�l�. � ....
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<br /> 7a-: .CENSUS TRAGI -3
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<br /> i: .............+�•r 3� ..... ........ Phone f.?....
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<br /> Addre / !'t*Y
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<br /> i Contra�.«cors Name`.. .,�r _-.G,..,._....... License# Phone . L
<br /> Inslaliatfon.wiil serves Residence Q Apartment House 0 Commercialgroiler Court
<br /> Motel❑Other....................................
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<br /> Numl a of living units:...... Number of bedrooms Gorbaa Grinder .
<br /> 9 ... Lot Size
<br /> :Public System name `
<br /> pWat uPPIY;. and ....:..... ....................................................Private , ti
<br /> Chad �f soil to a depth of 3 feet: SandSilt Cla
<br /> D ❑ Y ❑ Peat❑ Sandy Loam ❑ Clay Loam Q �Yn '
<br /> Hardpan[3Adobe jjr Fill Material.. If yes,type A'n
<br /> 4•3
<br /> (Nat Lpllan,�rhowiny..size of lot, location of s-otem in relation to wells, buildings, etc. must belplaced on reverse side) u-
<br /> ;NEW(INfTALLAflONi {No septic tank or seepage pit permitted if p4blic sower is available within 200 foot,)
<br /> ��4,PACKAGE TREATMENT j SEPTIC TANK �tSize..`Oi�.1� .er.�................... Depth fi� L
<br /> C' , .... . Liquid"
<br /> Capadty�iP?.0.,4 Ty ps�/ll Material. <.?�' No. Compartments
<br /> Distance to nearest: Well ...5 .... reds ^r s
<br /> r. .........Foup tion.�:S'. ,.Prop.Line.-,
<br /> i LEACHING LINE > No. of linesJ............. Length of Nh lin /... .�..,.......... Total `length
<br /> .-. e..
<br /> 'D' Box .... Type Filter A-,: erial� / � Depth Filter Material t
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<br /> Distance to nearest: We 11 .4�Ad rr :. i. Foundation .iZ. i_�.:...._.... Property Line•.�r o ,#'
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<br /> ' SEEPAGE PIT,: Depth .,.EZ..,5.. Diameter .�.,�3.....:... Number .....1...:: ... Rock Filled Yes,Q�'A No [{ t <�
<br /> ' Depth ......lo �. i. .. , a, <'4. ,
<br /> t Water Tablep .sp. ..Rock Size 02 d. .... r . < z P
<br /> Distance to nearest:Well ../...��
<br /> r .........................Foundation �, ....... Prop. Line .. g ... '
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<br /> RRAIR/A501110N jPrev.Sanitation Permit#............................................ Date . ..............................) s"
<br /> Septic Tank (Specify Requirements)
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<br /> i, Disposol"Field (Specify Requirements) .:.........:......l ...... ...t, 'Y!t4� ..- -�... .................................................
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<br /> t ........_. ....... ....... t ;
<br /> L) ... ........ ....,... ...........�.,..., .......... ..... .... �1 r .
<br /> :• (Draw existing and rt faired addition on reverse side) ;,
<br /> I he Y certify that I have prepared this application and that the work will be done in 00:01dance with San:Joaquin
<br /> CowNy Ordinances, State Lows, and Rules and Reguktions of the San Joaquin Local health District.Home owner or Ilan-
<br /> sed comb signature certifies the following-
<br /> "I
<br /> ollowing"1 certify that in the performance of the work frr which this permit is issued, I shall not employ any person In swA manner
<br /> as is bee. rAa-su,�J.ett to WV7maCompensa+tirllaws of California."Signed .. /:. Gt�j/.�rr�:.1::c 4„� Owner '
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<br /> t By...... ................
<br /> .............................. �s.G•+� .,rte._.. .J.:ty`..:.. Title . .................. .. f.
<br /> (If other*han owner')"'
<br /> wner) _.. . ...................._..............
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<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY.... .. 'i.,. DATE.....771.1-..7.4..........:.....
<br /> BUILDING PERMIT ISSUED............................ .. .........DATE. .........................................
<br /> ADDITIONAL CCMMENTS..........................................................
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<br /> ................. ......................................................................--'..,................................._...................,......................................................
<br /> Final Inspection
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<br /> Pe Y �,.•.... :... .:...................................................... ......................Oslo.....9.�..rT.. ..._..................
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
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<br /> E.H.9 1-'68 Rev.SM
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