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R OFFICE USE: <br /> l-7- APPLICATION FOR SANlTAT1ON POIT <br /> 0} <br /> : ---- .'_ --____ /' (Complete in Triplicate) Permit No. <br /> wl-<f 7&13 <br /> ir <br /> ---------------- This Permit Expires 1 Year From Date Issued Date , <br /> Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to con <br /> described. This application is made in compliance wit County Ordinance No. 5�and a -sting Rules-and construct and install the work herein <br /> JOB ADDRESS/LOCATION Regulations.. <br /> ------ ------- <br /> Owner's Name ------CENSUS TRACT <br /> ---__--__--- <br /> ---------------- -- <br /> A dress -------------------- <br /> --------- l -�- - ------------------ <br /> ---------------- -- -- -- <br /> - <br /> -- Phone <br /> Contractor's NameCity -- ----- <br />' . _ - <br /> - - - <br /> Installation, - o-- -e- ---------------License # ---------------_ ------ Phonel,serve:�wRes!dene art.__.V_ us '❑•Commercia)�❑Tader.Court :0 �j <br /> Motel [)Other__.---__ <br /> i Number of living units:_--- - -- ---- ---------- ---- - --- - ---- <br /> .-- Number of bedrooms _.___Garbage Grinder _______--_ � <br /> Water Supply: Public System and name - Lot Size -_---�iF1_xl p <br /> ------------------------- ------ <br /> Character of soil to a depth of 3 feet: Sand' # <br /> ----- -- Private <br /> YO, CIaY Peat_. .�.and j ❑ <br /> •---•.,_ .�] Silt ❑ S � : <br /> - y, Loam '� Clay Loam,❑ <br /> Hardpan� y <br /> p 3❑ Adobe ❑ Fill Material ------------ If i s, type ------ --------- <br /> (Plot play showing size of lot, location of system in relation to wells, buildings, etc, must <br /> NEW INSTALLATION= t be placed on reverse side.) 4 <br /> ( o septic tank or seepage pit permitted if public sewer is avpilable within 20 <br /> PACKAGE TREAftAENT� ( ] SEPTIC TANK' 0 feet,) <br /> ! � ) Size---- <br /> - <br /> ize:-- --------------------------------- r I <br /> ---- Liquid Depth <br /> Capacity _.------------------ Type ----- ----�`�� � .-- - - \` <br /> MafieriaL - No. Compartment! <br /> Distance to nearest: Well -_- __ . j - �� <br /> LEACHING LINE Foundation ------- -- -_ <br /> t ) No. of Prop. Line <br /> ----------------------- Length of each line------------------ ----_-_ Total Length - <br /> t e <br /> 'D' Box ------_- -- Typ e• Filter Material _ { - - - --------------- <br /> 1 1b- t Depth Filter!,Material e <br /> Distance tolnearest: Well ,--------- -------i PIT # �--�-Foundation.�=�-__,- Property Line' <br /> -. =_ - P tY <br /> Di meter -- -- <br /> � ) Depth ------ ----- Number <br /> Water Table Depth -1`' .------- t,�,- ------------- Dock Filled Yes ❑ No i❑ s <br /> ---------------------Rock Size <br /> Distance to nearest•.Wel _____t_C -' . <br /> I � 1 ----------------------Foundation f .p <br /> REPAIR/ADDITION(Prey. Sanifiafiion Permits# -.--_-• --__-___-_ - roP• Line .... <br /> _____-•--_ <br /> 1 �, Date --------------------------- :)' <br /> ------------ <br /> Septic Tank (Specify Requirements) - -__-t_ { <br /> ---- --- 1- - �J( ' <br /> ' --------- - �h <br /> ' t i <br /> Dis osal�` Feld {Specify Re u ements ,; f 1 r ----------------------- ------------- --- <br /> '_ .X <br /> ., • <br /> 1 <br /> t # ¢. . t ,. t ;� {q'S oZ ----- ------ <br /> el-Ply -------------- ------ -------------- <br /> ---- --- .._.g <br /> (Drawexistin anr� re -y--- <br /> quired_addition an reverse side ----------------------tt-------------------------- <br /> I hereby certify that 1 have prepared this applications and that the work be4done in acordance wir <br /> :.`�, <br /> County Ordinances, State Laws, and'Rules and -Regul+irtions of tlre..S"' Joaquin Local'Heal#h, D,ist�ict. Homeowner or ficen- <br /> h San Joaquin <br /> sed agents l*signature certifies th`e following: ; ,,Sr <br /> "I certify that in thee Rerformatice'of the work I'for which this-'perm#F is'-issued;i-shall-no employ an <br /> as to become subject to Workman's Compensation lavJs.of California.- y person on. in such manner <br /> Signed ----- ---- ---- <br /> ----- ------------ =------ ----- Owner <br /> By '" ` <br /> (I other, n owner} - ---------- :; Title --------- <br /> ----------------------------- <br /> FOR%69i :rJ ENT USE ONLY <br /> APPLICATION ACCEPTED $Y ._---_ 1 �_1 . <br /> BUILDING PERMIT ISSUED --------------- : --- :r v.{ i � . �- <br /> I ---------- DATE ---- _� , <br /> A�7DITIONA fCtMMEN -17:�� -�-� -- ATE <br /> `�. <br /> - L._ - <br /> ------------------------------------------------ <br /> --.- ---- --- -- --------------------------------------------------- ------------------------------------------ ----- <br /> Final Inspection by. ------ ----- ----------------------------------------------------------------------- -- <br /> N JOAQUIN LOCAL pHEALTH DISR.ICT -GJ� <br /> E. H. 9 1-'66'Rev. SM -� -f <br />