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r• <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit Na. 5�' <br /> ICornplsleinTriplicate) .....pg.+�............r.� <br /> ............................................... This Permit Expire,I Year From Date Issued Date Issued..f�..: „.J.C <br /> --� Application 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 de I co pit ce with County Ordln nce No. $49 and existing Rules and Regulations, ' <br /> JOB ADDRESSAOC TION G.:,, ,ttrG.4nZ.'/.f/. .....'. e?! CFNSilS TRACT ......................... <br /> Owner's Name ..:u rtrr''h . ............. ...................».. .PI}an .. ... <br /> Address y�. ............. �rf�t/ _City '• L/ <br /> Contractor's Nome. . ,....License# s"`/ZZ phone .`&c`e.dc:/: <br /> Installation will serve: Residence©ApartmeUi <br /> ouseq Comma I I railor Court 0 <br /> Motasl Q OtherS!� .. <br /> Number of living unitst............ Number of bedroom ' rba a Grinder <br /> ............ Lot Stae .lG.-�r.�.x.�..P�..7....... <br /> Water Supplyi Public System and name................................_...................._.............................................private <br /> Character of soil to a depth of 3 feeh Sand❑ Slit❑ Cloy ❑ Peat❑ Sandy Loom C3 Cloy loam❑ <br /> Hardpan Q Adabe to Fiff Material...... ...If yes,type........................... <br /> (plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse sidel <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sower is available within 200 feet,) <br /> Ito <br /> PACKAGE TREATMENT, [j SEPTIC T IC y�x?, }3!�'. /..._......._... Liquid Depth .... '. .,. <br /> Capacity� QQ.... TypaaP.411 lhsterlol. - t.r. No. Compartments :.» � ...Y.. ; <br /> Dfstance to nearest, Well .,,lci %�._.��.»...Foundatian�C�......»__Prop.Lino � S.c <br /> LEACHING LINE � No. of Line: ...C�_.......... Length of each line �,�» Total Length ..���.......... <br /> 'D' Box ..../... Typo Fitter Material rZA4J Depth Enter Material <br /> l !1 Distance to rwaaests Well Q. . Foundation 3.g2— property Lhts <br /> SEEPAGE AT Depth Diameeter Number . a�».. ,...__ Reck Filled YosX No[33 Water Table Depth ..r...GP_A r__Rock <br /> Distrnce to necrosis Well...ls _._.» . . .....Foundation'Z4.L?..... Prop. Line <br /> t <br /> REPAIR/ALtL9MON(Prov.Panftation Permit#..............._.._...................... Date.�_ _ ....._._».......I i <br /> Septic Tonk(Specify Requirements) ........... _..... ......._.... .r......_...._...._...._....__..»... .»._.. t . <br /> y Disposal Field ISpedfy Roquirements) <br /> ....................................r..... ............................................. <br /> ._....... .... ......-..».... .......__...» ............»...�....... .. <br /> ..........».......................................... ... .. »,.»...._..»...................... .... _ <br /> tw.....sting and required addition an rsveisa.side} <br /> I hmhy r*M$y that I have prepared this application and that the work will bol-done In accordance with San Jaaquln' h <br /> County Ordinances, State Lary-,and Rules and Regulations of the San :oaquln Local Kahle 01strict.Nome own"or Ikon <br /> , <br /> scd agonts s#gnature certlfies the following: <br /> "I corHfy that In the performance of the worst k4r which this permit is Issued, I shall net employ any pereen In such manner <br /> as to bot s su [qct It rk ad's Compen ors lava of California."Signed.. .t fC..................Owner <br /> By................ ..... .. {d .�..............I....... Title................................ . .................................. <br /> lh'other han ow rl ; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. s ..... DATE .. s:`S n 19......_..._......... <br /> 9 BUILDING PERMIT ISSUED.... ...............».........................................r.......'......................:.DATE..........�............................. <br /> ADDITIONALCOMMENTS................................................................................................................r....__... ......_....» ...... <br /> .-....»..........•........ <br /> ...rr...... ............».......w.................................. .........."'a..w'•.:........r......a <br /> t Finoi inep�ction'by�' :::. ': r::: ... :...»..: ::�» .::: ::::�:::.....:." ..Dat::. � 7:~:r ::.........::... <br /> s SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> a 'C 5$ Re., t. <br />