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FOR OFFICE LISI:: i v'=- <br /> APPLICATION FOR SANITATION PERMIT <br /> ................................................ � Permit No.76.�IA :Y. <br /> lCompletoIn Trlpficataf <br /> ` Is W`if>l zit ei iYwr Frem Dada s�t sue`d t?ab_lasuedl. <br /> . <br /> App >{ * re mo" - �u, oca ea Di ct permit to construct and install the work herein. <br /> 400 <br /> described. This app-licatlon,is Made In compliance with County Ordinance No. <br /> I Ow ` 549 and xisting Rules and Regulations, <br /> JOB ADDRESSAOCATION ....... .�7CENSUS TRACT .......................e.. <br /> ... <br /> -Phone .................. ...............Nam ... . <br /> Address ........ �. ."�. .....L, .......... Clty - .............:r .rn. <br /> Contractor's Na` 6 �,�EZr-d-- -- ... e,rQ£;,c.,A:u.,, 1}cenie <br /> Installation will serve: Residefice {Apartment House E] Commercial Uraller Court-E3.,� <br /> # Motel Q Other........ ...................... <br /> ...Gcrba Grinder;^` Loi <br /> Number of ._....> mber'ot oorns . .... - - - .�. <br /> living units:...... Nu <br /> Water Supply: ' lic,System acid name _ 3. � `-............................»»......_..Private" [ <br /> CFiaracter'of soil to ci"depth of 3 feet: Sanclo�l Slit❑ CfoyE [j Post❑4 44ggd t_Loam° Clay_lo Q' <br /> �tiardpan-[3 -Adobe-.p.. flli7Materioi " If`yet;-�ypc.............: ........ ' ..� _ = <br /> f <br /> ,Plot plan,1 showing size of lot, location of system in rotation to welts;,:buildings, etc.,must be plated on reverse all <br /> NEW iNSTALLATIONs (No septic tank or seepage pit permitted if publt&^sewer is available within 200 feetJ��-�� f <br /> fXh ���.. Liquid Depth Com.........?..,........ <br /> s PACKAGE 7REA7MENT { } SEPTIC TANK,,, Size.. ! � l <br /> i ► i Capaclty� G !C�h� TYPe , tenial. f _ No. Compartments - .-----fes. - <br /> r rte! Distance to nearest: Well ---• Foundation/ _. Prop. . <br /> f cs <br /> LEACHING LINE No. of Lines . .............. Length of such line.....J&T_-......... Total Length 4'0...---....._.'.. <br /> a�fs D' Box <br /> .... Type Filter Material ....... .. .....DepthFilter Material /R......................_......... <br /> . <br /> • Distance to nearest: Well ............. Foundation <br /> ._..... Property Line IS ................ <br /> ! ' 'FIT I Depth --le......... Diameter , k1f *Number ........i):) --•� Rock Filled Yes* No [3 , <br /> T <br /> % �„ Water Table Depth ...�rl............. ..................Rock Siie _.-. ..`.... : ......... j <br /> { Distance to nearest:Well ..1A6V.........................foundatlon ....... Prop. Line -- <br /> i REPAIR/ADDITION{Prev. Sanitation Permit <br /> ............................................ Date .................................. <br /> { <br /> SepticTank {Specify Requlremenlsl ........................................ .................................................................................................. <br /> Disposal Fiela (Specify Requirements) ...........................-.......... ._......_........ ...............-................................................... <br /> t R •� <br /> 31 ; <br /> -- --....-•-•---•-•--•.............:..........................................................._.......... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work wilt be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules, and Regulations of the San Joaquin Local Health D1str dt. !Lame owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "1 certify 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 subject to Workman's Compensation laws of California." <br /> Signed ... ................Owner . ... .. .. t <br /> Sy ........... ........ <br /> ...... .............. Witte <br /> Of other than owner) <br /> A-OR EP T NT US ON <br /> APPLICATION ACCEPTED BY. t�td DATE .�/�'- �- ...... ... <br /> BUILDING PERMIT ISSUED ................................ -- •. ----•-. ---•--DATE ------ ..................7.............. <br /> 4QDIT10NALC0MMENTS_..............-................- -.-:.::::.. ..._-._..............._.._.�.-..:._...—,r.,- �.., ....._._._......... . ..,. . .... <br /> .... ....................... ... ..... .. ----•- •--....... . _ ....................................................I.......... <br /> .. <br /> �_ ___ _. -- J ..........:.........:............................-------------... <br /> ....................................--.-----•......._...............................-........._.::,......._.........."L�- <br /> ... <br /> Fina! Inspection by: ......... Date . FJ .............. <br /> EH 13 24 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 31'1 <br />