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FOR OFFICE USE: <br /> FOR SANITATION PERMIT <br /> Permit. No. .....'� <br /> (Complete In Triplicate) <br /> ............... ...... ......I........._I <br /> ............... .......­........... ................. This'Permit Expires I Year From Date Issued Date <br /> Application is hereby made to the Son Joaquin Local Health District for a perr6it to construct and install the work herein <br /> described. This application is mode in compliance with County Ordinance No.,549 and existing Rules and Regulations. <br /> JOB ADDRESSAOCATION .........1-............ <br /> ................... TRACT <br /> -y- ...... <br /> Owner's Name ...... ...... ...................................................._..............Phone 7. . ..... <br /> ............4....... <br /> Address ... ......... ........ ................ .......... ............... City .-J&C",Ct......---•......--•------.......----. ........ <br /> 01_6......Thone <br /> Contractor's N"ome ..f ------ .........................................Lic6nse #9.5.7 <br /> 0 Corn ia <br /> Installation will serve: ResJdence RT Apartment-House merc� I 'C]Trailer Court 0_, <br /> motel ED Other <br /> ......................................... <br /> e nits:.......... :Num: ber� of 6ediooms ..............6 /f <br /> Number of living u ....Garbdgi Grinder X.0----- Lot Size <br /> ........................... <br /> L <br /> . <br /> SUPPI�: <br /> W6ter PuLlic System and name ........ ....... ...... .................. ................. ..................................Private <br /> Character of soil to a f h de to3eet;� and 0 <br /> p fSSilt 0 Clay 0 Peat 0 Sandy Loom Clay Loom 0 <br /> I <br /> ty <br /> Hardpan C] Adobe-E],. Fill M6terial ............ If yes, pe ... .................. <br /> (Plot plan, showing size of lot, location of'sysiem in relation to wells, buildings, etc. must be placed on reverse,side.) <br /> NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT StPTIC,TANKI ----------------------- Liquid Depth -q:-p.T <br /> . .........I....- <br /> Capacity .................... Type Com __. . Material.............. ....... No. 'Compartments �?L............... <br /> Distance to nearest- Well ...........:........Foundation BIT---------- Prop. Line,�2.a2l..L.."-V <br /> 01 . q I?..F.. - - (5, <br /> LEACHING LINE No. of Lines -- ----- ------------ -Lehgth-of each -line, _7--- <br /> .'D' Box _Cvs,_c... Type Filter Material Depth Filter Material oqo."......I....... <br /> Distance to nearest: Well ...... Foundation3.o..F] ........ Property Line ..... Tn." <br /> --SEEPAGE PIT Depth ... ....... .......: Diameter ................ Number ............................ Rock Filled Yes E) Na C3 <br /> Water Table Depth .......Rock Size ........................ <br /> Distance to nearest. Well ........................................Foundation .................... Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......... .................................. Date ............................. <br /> Septic Tank (Specify Requirements) ............................•--------••------•---- •-------- ..............­­................. .......-t.......w.....-0010 <br /> -Disposal Field (Specify Requirements) ------- .............................m............................11............................................... <br /> H <br /> ---------------------------------------------------------------------------------------------------1-1-1------- --------------------------------------------4.....................I.......... <br /> ....................... ----------------------------------------------------- .................................................................. ............ ....... <br /> :;-(Draw existing and required add ition--on-reverse-si de) <br /> I hereby certify that I have.prepared this application and that the work w,ill be Bono in accordance with Son 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: <br /> "I certify that in the performance of the work for which this permit 15 issued, I shall not employ any person in such manner <br /> as to become subject to.Workman's Compensation laws of California." <br /> Signed <br /> ....... ......... ...................................... ...... Owner <br /> By ................................................. ....... Title .....C-,-.a A <br /> --------------- -------- ......................... ...... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> -7 <br /> APPLICATION ACCEPTED BY`­�......: . . . ....... ......L.- .... . ... . ... .. ..................., DATE ........... .. ..... ........ . <br /> BUILDING PERMIT ISSUED .....:'I!' , . . I <br /> ..... .-.......... .................................... ........................L.............-DATE .............................. ...... <br /> ADDITIONAL COMMENTS .......................:....... .....................................;........... <br /> ............... .............. ._..s.........._...-........-...... <br /> _.._.;..•...__. <br /> ------...... ............ .. ...... .............• .................---•------•----•---------- <br /> ............. ........................... ........................... ------------------------------------------------------------------*--------------- ......................... <br /> .......... ......................... <br /> . ... .... .. ... ...... -- -----­....... .................. ............... <br /> ,. <br /> ......................... .......1.................. <br /> ------ .......... ... .... .................. --------/---2 <br /> --- - ----- ---- ... ........ ... . e <br /> Final Inspection..bi: ................... . . ..Dat <br /> ,SAN.JOAQUIN -LOCAL ZHALTH DISTRICT <br /> r- w 13 241_'AQ Dau A;AA 7/72 3 X <br />