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FOR OFFIC"E'IJSE�" <br /> ` ,�XWUCATION FOR SA�N,]1TATION PERMIT <br /> �s� .., 1 <br /> Permit No <br /> to in Triplicate) Y . <br /> ______ y;. .. <br /> This Permit Ex ares Date Issued -- - r -. <br /> (Complete <br /> �� . p 1 Year From Date Issued <br /> Application is hereby made to the San Joa in,Local,­Health District for a permit to construct and install the work herein <br /> pP Y t ,ql� „�. <br /> described. This application is made in.compliance with`County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . o�o_G,__ .---- _ <br /> 1 r",, <br /> --- - Q_�..'T-0/�I-----------RI_POAI-------CENSUS TRACT -- ----- ���� ' <br /> Owner's Name 4 �n SSS L3�- --------------- - ------------ ---------- --------Phone . <br /> Address ----- -- --- n - }FZoL,Ta City At-PO-4 <br /> S C-------- <br /> Contractor s Ndme-_ OIAI E ; T:A <br /> ' - ------.License #---------- -------------- Phone -------------------=. -------- <br /> Installationwill.serve: 7 Residencepartment'•House,D Commercial :]TrailetCourt i❑ <br /> : s , <br /> V Motel ❑ Other -- ----------------------------------- <br /> Number of living units:____ _.- Number of bedrooms _3-------Gdrbage GrinderA1_0-- Lot Size __________ ' <br /> Water Supply: Public System pnngmes .x ---- <br /> Private <br /> ___ - <br /> Character of soil to a depth of 3 feet Sand' Silt fly. Clay ❑ y Peat❑ Sandy Loam ,I] Clay Loam <br /> Ha 'an `�'Adobet>, - �. <br /> p ❑ t❑ :Fi!!'Material --- If yes; type ._______ _. <br /> (Plot plan, showing size of lot, location of system,,in relafibn to wells, buildings, etc-must be placed on reverse side.) O ] <br /> � 1 <br /> NEW INSTALLATION: (No septic tank or`seepage it permitted if public sewer i Available within 200 feet,) "? <br /> 019 <br /> PACKAGE TREATMENT SEPTIC TAMC, - Size.° -__X_I rX_ .-'-.,,Liquid Depth S___?— -___- O t <br /> Capacity 5�r Q_-Type f7mr-6.BMaterial_�CD C___ No. Compartments ______-�____••__:.___ <br /> Distance to nearest: Weil ___----------__---------Foundatian l�f-_•----__tProp.,Line ----- ________-_-_-_ <br /> - if'' -T i !' Lr " kliz <br /> LEACHING LINE J;} No. of Lines - -_____.-_ 10 <br /> Length of ea ch'line___'.__�, .� Total. Length' <br /> .-__1 ______________ <br /> 'D' BoxX46F-5___ Type Filter Material Q_C _.Depth Filter Material _______/ ___________ .............. <br /> n .,.... <br /> Distance to nearest: Well. _T�a_w_-r-:���:;,Founda4ion"_ ,0 '1' "'"'___t'roperty Line. ----------- <br /> i <br /> SEEPAGE PIT [ ] Depth ------ ------------- Diameter ---------------- Nu;Y s mber.,_,,,__,._-__-___- Rock Filled Yes ❑ No 0 <br /> .-mak s <br /> Water Table Depth ------------------------------------------Rock-.Size,= :_._`-. , <br /> 3d V+4a .. I'd 1- ----- <br /> 1 _ _____ <br /> i_ <br /> Distance to nearest: Well --i-------______________________,____Foundation ---------------------^Prop. Line ....-__...____-_ <br /> REPAIR./ADDITION{Prev. Sanitation Permit# _______ - �_ Date __________________________________I <br /> Septic Tank (Specify Requirements) ---- -----------------i------------------------------- ---------------------------- ---------F----------- ------ <br /> Disposal Field (Specify Requirements) --5-r------ --------•- ----- -- 4--------------------------- ------------------- - ------ <br /> --------------------------------------------- X-----==---------------------------------------------------------- ----- -------------------------------- <br /> -------------•---------- <br /> --i= <br /> ___________________________ _k_ '_-t�lt _1_________._ --------------------------- ___________________ _____-___--_-_-__ __._-.__-_�____-_______ - - _ <br /> __ ___________ - <br />'-"" 3Drawezisfing and requirecFdditi on on reverse <br /> I hereby certify that I have prepared this application and that the work will be_,done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District Home owner or licen- <br /> sed agents signature certifies the following: F <br /> "I certify that in the performance off a work for which this permit is issued, I shall not employ any person in such manner <br /> as to becom s Wor an' ompensdtion laws of California." I j <br /> Signed --- <br /> - - -��---- - - --- - - ----- Owner <br /> BY ----------------------------------------------------- .................................... . Title - -------- -- ----- ---- ---- ------ --------- -------------- <br /> (if other than owners <br /> FOR DEPARTMENT USE ;ONLY l <br /> APPLICATION ACCEPTED BY ----- -------------------------------------------------- ----------------- ----------- DATE --------7- <br /> ---- -7y �� �` -------- <br /> BUILDING 'PERM IT"ISSUED":----�'- --`-'=--��-•T -` - ------=------`=`�--, _ '__ _.DATE ----�--`-"�==----------- - <br /> ,nf� I <br /> ADDITIONAL COMMENTSif< ' = I t 5 �' � �1 <br /> ------ ---------------------- ------ -- ----- ---- -- ---- = ------------ - -------------------------------- - <br /> --- --- --- <br /> Insp ' b ----- -- -- - -------- ---------------------------------------.Date ---------- ---- --- -- <br /> Final In _��` <br /> SAN JO IN L AL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />