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<br /> APPLICA7;ON FOR SANITATION PERMIT
<br /> IComple14 in Mplicatel Permit No. ,.7..0-.9,x.,,•,,,
<br /> ..........................
<br /> This Permit Expires I Year from Dale Issued Date Issuod
<br /> Appiication is hereby made to the San Joaquin local Hahlth District for a permit to constirve and install the work herein
<br /> described.This application is made In compliance with County Ordinanct No. 544 and existing Rules and Regulations,
<br /> J09 ADDRESS/LOr.ATION Shed Station - Moreland b Hammet 5toektoa
<br /> Fille ......„..............._.......... ... . ... . ....CENSUS TRACT ......_......„.„._...
<br /> Owner's Name .... _-Const.
<br /> «r bG40 Sxn Jum ...
<br /> .._.,_.,.._»«.._..-_..... -- .........Phone_..............�...___._.
<br /> RAddress ..... .. n...............................I..........._....�.b. city.�C e
<br /> Contractor's Name,Corti!° !; Sewer Inc. License . +5417 ........,, Phano �+k(!- �},�_.
<br /> ........................... ....„...._..„_».. .. .....
<br /> r- !nstallation will server Residence®Apartment Houssn Commercial CITrailer Court ❑ ..~.
<br /> Maul 9}Otho......SAr.9.iC.C-AL1191 .A__,. C
<br /> e
<br /> Number of living units............. Number of bedrooms ....„..— ....�.......Garbage Grinder Lot Size
<br /> Water Supply: Public System and Hama
<br /> Privict to
<br /> 13
<br /> Character of soil to a depth of 3 feats ,:and❑ Silt❑ Clay ❑ Peat© Sandy Loam❑ Clay Loam❑
<br /> !^�! Hardpan® Adobe© Fill Material...».......If yes,type..
<br /> ' IP10 plan, showing size of lot, location of system in relallon to wells, buildings, ate. must be placed an reverse side.) { I
<br /> ,.� NEW INSTALLATION: (No septic lank or seepage pit permitted If public sewer is available within apo feat,}
<br /> PACKAGE TREATMENT () SEPTIC TANK Slze.___..«....»...»__,_._».,_........__. Liquid Depth
<br /> s - .».•
<br /> capacity...«............... type .......» .._.„ fdahrla!«�....._„_»„. No. Compartments „.... �._^~.
<br /> r i Distance to nearest, Well _.»-..„.,,,,_-,---_Foundation.. prop.LErte,,,«,
<br /> LEACHING LINE {) No. of Lines Length of each lira._ Total Length r �
<br /> 'D' Box Type Filter Material _.Depth Filter Material _...,......��
<br /> ,i Distance to nearosh Well_...�.�,,,,,.Foutltlatian
<br /> operty tkw
<br /> p3_,;,„, Nutnbsr.,««__�-.r r... Rea SEEPAGE FIT, Yea ol�S
<br /> ( j Depth „.... Diameter
<br /> � Water Table De theek Size f
<br /> Distorts to nearests Well_..,.., 1� r C
<br /> Foundation ... {�—r Prop. Una _. .,..
<br /> REPAIR/ADDITION IPrev.Sanitation Permit#.,.„.„
<br /> ....................Dare _} 1
<br /> f� Septic Tank (Specify Requirements) ..�...„..� � ._..„......_..»..«_
<br /> Disposal Field (Specify Requirements) ..._»„«,-„-,,,_.«.w......«.__„_....»,.«......_..._.„._„.....
<br /> z. t 1 ..•....„...„..........„.........,_...._.... .« (Draw existing and required addition on reverse side)
<br /> et_$ 1 hereby cw'Nfy that I have prapared this applicatien and that the creak will be scene In accordance with San Joaquin
<br /> (ln County Ordinances, Stale Lowe, and Rules and Regulations of the Sen Joaquin Local Health LllsMtl.i8oma owner or licen-
<br /> sed agents signature certifies the followings
<br /> "I certify that in the performance of the work for which this permit is issued, i shall not employ any person In such wanner
<br /> as to become blexst to Workpgan's Car4❑pensaHen lows of California.”
<br /> s
<br /> Signed.............t. . i f`!�....
<br /> '.�� Owner
<br /> — - - - - By :.......(If other than awn..................................................
<br /> .............. . JHie.................................................... ...,.._....„. -- — ---
<br /> a
<br /> FOR DEPARTMENT USE ONLY
<br /> a=pLlCATION ACCEPTED BY
<br /> ... :`. L ......„....„............ ..... ...»:..............„.... DATE.. I�t .1`7��.........._.... .
<br /> AVILDiNG'PERMIT ISSUED .... .
<br /> nDITIONALCOMMENTS......................... .. .............»....._..r......................................DATE.»„......... .. ..._...._„,.....:.
<br /> I77.„....„.......... .»::».._........ .„........._ ..... ... .... „..«....„.........«„........� r� „`........«._..._............
<br /> Final iwspedion by,.....A »h. :ice......„... .. ..'....«.......... ....... ..... .«................. ,,.« lt�.rl.�v.............._.. .
<br /> .,_._................«..................Date
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> �f
<br /> 6s, - . AC
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