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Z, <br /> FOR OFFICE USE: AT 0 P RM <br /> I W E' IT <br /> -APPLICATION FOVSANIT Permit,N.& <br /> ------------- ------------------------- (complete in TdPlicatq)�% 0 <br /> Date issued -----7:- ----- <br /> This Permit Expires 1 Year From Date Issued <br /> --------------------------------------- ------------ <br /> ---- --------- ----- <br /> jealth District for a permit to construct and install the work herein <br /> de to the San Joaquin Local I ig Rules and Regulationst <br /> Application is hereby ma Ordinanc�, 549 nd exiS ir <br /> ompliance wit u <br /> ,j,catio', is made 'in c 11 <br /> described. This apf -----CENSUS TRACT ----------- <br /> ------- ------ <br /> JOB ADDRESS/LOC hone ------il----------------------------- <br /> -- ----- -------- <br /> ---------- - ------- <br /> Name ---------------------- ------ <br /> .... ..... <br /> owner's Name __/------ <br /> -- --------- --- one`:�.�16--- --------------- <br /> C <br /> Address ----------------- - --- ----------------- nse # Ab -- ----- <br /> contractor's Name ----- --- ---- ----- - <br /> I partment House,F-1 Commercial [:]Trail I er Court <br /> installation will serve,. Pesidenc.e <br /> Motel C]other -------------------------------------------- <br /> ----------------------------- <br /> Lot Size ----------- <br /> 6�Lin its: drooms3- - -------Garbage Grinder <br /> Number,,pf-livin H777?-Number of be --',Private <br /> ----------------------------/`O_�------------------------------ <br /> Water SupglY- Public Sys em and name --------------------------------- <br /> Clay n Peat 0 Sandy Loom �E] Clay Loam,[], <br /> Character of soil. to a dep, h of 3 feet: Sand�7 Silt El . Mciterial --------- type ----------------- 1 , k <br /> Hardpan El Adobe- Fill If yes, ---------- <br /> rse side.) <br /> 'lls, buildings, etc. must be placed on eve <br /> of lot, location of system in relation'16.We� <br /> (plot plan, showing size, <br /> tic tank or seepage pit permitted if p66jic sewer is available withi�200 feetj/ <br /> NEW INSTALLATION: (No sep <br /> I - Liquid Depth------ -------------- <br /> ----------------------------- <br /> PACKAGE TREATMENT SEPTIC TANK All Size-I i__� <br /> --/1%< ial------f--------------- No. Compartments ------------------------ <br /> T ....Water 0. <br /> Capacity -----------------/ ype ----------------i , . ----Foundation ---------------------- Prop. Line ----------------------- <br /> . Well/----------------------------- - 4 ", <br /> Distance to nearest' - —_ -1 Total Length ---------------------------- <br /> ��/---- Length of 'each line---------------------------- 11 41 <br /> LEACHING LINE No.4 of Lines --------- - ------------------Depth Filter Material -----------2-------------------------------- <br /> 'D' Box ----- ------ Ty�e Filter Material 1k 1� i - . <br /> Property L ne --------------------- <br /> Distance to nearest: Well ------------------------ Founclatiori------------------------- 1� <br /> It I t ber ------r------------------ -- Rock Fille Yes El No C3 n <br /> SE I EPAGE PIT Depth ------- Diameter ---------------- Nurn ,,, I 1 1-1 1? <br /> ! - ----Rock size ---------- <br /> lWater Table �e"th -------------------------------------------- ---------------------- I <br /> p <br /> Pro Line _-----_----- ------ <br /> ---------- ------ <br /> .....Foundation <br /> rps <br /> Distance to nea t, Well -------------------------------- -- <br /> Perm- -------- --------- ------- Date ---------- <br /> REPAIR/ADDITION(Prev. Sanitation --- ---- ---------- <br /> Septic Tank (Specify.Requiremen, --------------- <br /> 1 ---- -- -- ---- ---- -- -- <br /> R quirements) - -------/7- <br /> Disposal Fiel� (S ed y el ___j ---- ------------------------- <br /> - ------- -- <br /> ------ --------- <br /> ---------- ------------------------------------- --------------il--- ----:----- --------- <br /> ------------------ erse side) <br /> exis in4 and required addition on rev <br /> once with Son Joaquin <br /> I hereby certify that 1:have prepared this application and that the work will be done in accord <br /> i the Son Joaquin Local Health District. Home �wnsror licen- <br /> County Ordinances, St�te Laws, and Rules and Regulations of <br /> A <br /> ature c, ifies the following: t <br /> sed agents sign nploy any P rson in such manner <br /> "I certify that in the 'rformance'of the W' ork for whNh this permit is issued, I shall not er <br /> laws of Calif*rnia." <br /> as to become subject to Workman's Compensation /1' <br /> Owner <br /> -------------------------------------- 4. <br /> i- ------------------- <br /> Signed -------- ---- --- -----I---- ---- - ---- --- -------------------- <br /> Title, ------------ <br /> ---------------------- --- <br /> By ------ --------- - -- -- - -------------------- <br /> otheltha o ned <br /> IF TMENT USE ONLY �........... <br /> DAT E --- ---- -------------- <br /> APPLICATION ACCEPTIED BY ------- ----------------- ----------------------- ............ <br /> DATE --------- <br /> --- ---------- --------- --------------------------- -------------------- <br /> BUILDING PER, IT IS�UED -------- - ---- - ----- ------ - ------- --------- ----------- <br /> ----------------- <br /> ADDITIONAL COMM.. T -------- ---- - ------------- -------------0---------- ------------ ------------ <br /> I-- ---- ---- 1��, ­------------ <br /> .jV Z-6-71---------- ----------------------------- - ---------------- <br /> ---------- ---------------------------------------------- 11 <br /> ------------------- ---------- ----i------ ----- ------ -- ------­ - ------------- -------- ----------------------------- d------------ ------ ---�­------- <br /> ------ ---- ------------------ ------ ----------- -------------Date 41 - ----- --- ----- <br /> Final Inspection by: -- --- - ----------------- ------------------------- <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> E. H. 9 1_'68 ev. 5M. <br />