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FOR OFFICE USE: `Z���( 2C�
<br /> I _ 0
<br /> ..-.... --•.........__._............... .... APPLICATION" FOR SANITATION PERMIT
<br /> t Permit No.
<br /> "+
<br /> _ (�p '•�s in Triplicate} •6�•
<br />......1-11---..............•.••......-....._.... This Permit IExpir' s i Year From Date Issued Date Issued
<br /> Application is hereby made to the San Joaquin Local HealtI District for a permit to construct and install the work herein v'
<br /> described. This application is ode in comp lance nth C `'u Ordinance No. 549 and existing Rules and Regulations:
<br /> JOB ADD /
<br /> _ s5 LocATlo �. 1�r..$ ,,,,�//��
<br /> i NG. AMc�'3'►�... ... ......CENSUS TRACT ......................• �+
<br /> _ _
<br /> ' .........
<br /> , .Phonerq
<br /> ".r s .?]
<br /> �!ss
<br /> ...-.... •.. City ........ i ' - :::::
<br /> Contractor's'Name �' ' , ' ;
<br /> ! ll -•- .. Eicer�se#•vim «�„Plititi� .. .:
<br /> Installation will serve:.r ` Residence-X Apartmenfi House❑ Commercial ❑Trailer Court. ❑ -
<br /> • �. Motel.❑.Other ...,_,.
<br /> Number of livinublic'S AD
<br /> `Number of,bedrooms
<br /> g
<br /> n'
<br /> P
<br /> Water Supply P -
<br /> ystem;and name, ! -r
<br /> arbage Grinder .... Lot.size.
<br /> i .Private'
<br /> Character of soil to a depth:of 3 feet: Sand L7 Silt❑ Cia
<br /> i. y ❑ Peat❑ Sandy Loam C] Clay Loam
<br /> € t Hardpan c Adobe 0 Fill Mpter�al ... If yes,` pe ..._ y I
<br /> Aoki
<br /> - -
<br /> {plot
<br /> plan;.showing.size of.lot� location.of system in rela4ion,to yn ells, buildings, etc. ynv&be placed on_reverse.,side,}
<br /> y
<br /> NEW iPJ5TALLATiQN {No septic #ank or seepage pit perrri�tted if pvblit sewer:is avail 20.0 feet
<br /> PACKAGE,TREATMENT
<br /> d e within �l.,x J/
<br /> [ ] S(=PT1C TANK ] Size. ��- !r 5 Lrquid 6epth -
<br /> a Capacity ,Type cz. _ k... Material �
<br /> a Distanee,,90 nearest: We€! '• , . ' N
<br /> o Cori'}partments
<br /> Foundation .
<br /> �. L
<br /> 1 �
<br /> f
<br /> LEACHING LINA ;_. -• • • •- •. . p
<br /> No. of;.lines .. Len thy., 1...-
<br /> M g of i ach line:�7'. .. ..... Total Length 4 m 1
<br /> "Type filter°Maferial % r , 'Depth";Filter aterial"........ `::: )
<br /> } r}r
<br /> Dista ee°to:`nearesti WeIF Foundcit�ori
<br /> SEEPA De
<br /> .I a �a Fs3 < Prape
<br /> ,[..�... .._...; Dept rDia r Nu - -Rock,; Na
<br /> err PITC `;,.-.. = _.•:.... Yes-D
<br /> P - mete miserr
<br /> Water.-Table.Depth, I «_....:.. y� ... ;.... Rock Size
<br /> t
<br /> .° : Distance to bearest aWell
<br /> w, , r... .
<br /> I fi
<br /> _ Foundation Prop. Line
<br /> RgPAIR/ADDITION(Prev. Sanitation Perm at
<br /> Sepflc Tank {Specify .Regvire}ments)F r 3 i jR
<br /> (Disposal' Field {Specify Requirements(
<br /> r
<br /> ._.... ........... .. r ;....
<br /> - e
<br /> ------------
<br /> (Draw existing and required addifion on reverse side] -
<br /> 1 hereiiy certify that i nave prepared-this appiiicution acid th at the;work will lie done,lin accordance with'San; Joaquin
<br /> County Ordma°Hies; State slaws,,:ancl`R4 es"a'nil',Reg'uiations"''a#'the'Siin Joiigiiin'f;otal"Health;Distract: H�iine "owne;ri`+s� 1 ten
<br /> sed agents.:signatuire certifies the followin !
<br /> i;certify that in the performance of the'work#or which this permit N issued, l shall not e.'Mplor any person in, rnonne�r�
<br /> g"to loecdme subje fo. orlon n's Campensation laws of�61ifarmii" , '
<br /> as ed
<br /> Si n i : ,
<br /> i .......
<br /> Owner t
<br /> B
<br /> EJ .. .. ... _..---• ik'_. Title'- ._ .. -- - - ...................!
<br /> {If;other than owner) i 1 )
<br /> DEP TM'ENT U5E ONLY.
<br /> APPLICATION ACC9PTED BY - :
<br /> � } ...........6 Y i s•w ..+._
<br /> l3U!'LDING�PEkMIT ISSUED :...,i. ?..... , �
<br /> ADDITI : .........� , I ` ..DATE _':..
<br /> f �+
<br /> ONAL COMMENTS ;I
<br /> - _ __ 44
<br /> ' _,_" .
<br /> p• Y._..... .__ i .. ;.. ..� 4
<br /> Final Ins ection by. Yai r Y . . :.. .�. .. .: ,
<br /> ; Dq
<br /> SAN j6 U LOdAL .HE,ALTH DISTRICT ^ ti ( i {
<br /> • r� - ....... .. - ak,::W_d....uaa.,,._t4.:a'.��kY_awa.w.1..•.efl. ..e
<br /> F. H_13 24 ti--ma P.- +," � -
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