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FOR OFFICE USE: ' <br /> •..... APPLICATION FOR SANITATION PERM11T - �F <br /> �,;: ........ (complete 1n Trippcate! Permit No. --,75 <br /> :: ... :...:................................. Phis Permit Expires 1 Year from Date IssuedDate Issued ............. <br /> � <br /> Application Is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made in ca fiance with County Qrdinance Na. S49 an ..existing Rules and Regulations: <br /> 2 ct1`- <br /> JOB ADDRESS/LOC AT Ot ._.. . � . . .. . . �-!^�...1 .`._ ..CENSUS TRACT <br /> Owner's Name ..... 77 -- ......................... �. Phone Q._3�.' Zl j i <br /> Address . ...................`,3.�1_�. ._. ..-............ ..'City ...._ :•.....-... . ..-. <br /> Contractor's Name .. -- ..._` ................---..Licensee ,, ... Phone ... � 6111 <br /> Installation will serve: Residence Apartment House Q CommerclalbTrailer Court Q <br /> Motel❑Other :... ! <br /> Nuni t'r of living units:__._.__ i ; .�� <br /> � g .. Numhet of bedrooms .... e Grl�nder .....__..... Lot Size .... �...1-�......�... ........... <br /> Vote' Public System and narrio ... ....:...-. . ...................................... . .: : «: ... ...- .Private <br /> Chiaracter of soil to a depth of 3 feet! Sand Q. SIlt Q Clay Q Peat Q' Sandy loam Q Clay Loam <br /> t Hardpan yes <br /> � ] Adobe fill Mlaferial li ,typt <br /> !Plot plan, showing size of lot, locatiop of system 1; relation to wells, buildings, etc. must be placed on reverie side.) ; <br /> NEW INSTALLATION:­.-I(No-sepis tank or seepag pi permitted if public sewer is available within 2001 feet,l 1� <br /> PACKAGE%TREA`TMENT [ a SEPTIC TANK, \Size.. ...xL.:ill ...................... Liquid Depth ....��.... <br /> Copa�W'Y 6 U j, Ty - " Material �iQF ►_ No. Compartments :. .... <br /> Distance to nearer Well ...., `...`�..�.tf ....Foundation Prop. Line .................. <br /> LEACHING LINE �( No. of lines ...-._.,1.. .:.......... Length of eckh fine...... '4_.. ...:..... Total Length ...Zo.............,.. <br /> 'D' box -:__. . Type Filter Material 4- :i3epth Filter Material ../ ........................... <br /> Distance to nearest, Well ....d _. ounddtlon /.�..-? •--...... Property LineP............... <br /> £ <br /> SEEPAGE PIT { J Depth ........::.......... Diameter .......... Number `...... .. Rock Fitted. Yea 0 f+f0 i) <br /> " <br /> I Water Table Depth __:___-.Rack Size .....---•- }i <br /> 'Distance to nearest: Well ........... .�.� .- - ..Foundation ..... Prop. lute <br /> . . <br /> { ` <br /> f . .._. <br /> REPAIR/ADDITION{PreySanitatianParmit .............. .:....... ` 'Septic Tank fSpecify Requirements) ... ....... ......:... . ..:........ ..... ....... .........................:.... <br /> Disposal Field (Specify Requirements) _.......--••----.:...-•----•-•-•-----•.................... ................................................... <br /> .. <br /> . -.-•--••--........a. .. •-----••.................... ......................................... <br /> ..............• •- <br /> ,I <br /> _............... .......... -• <br /> lDraw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done In accordance with San Jodquln <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HeaII&Dlsidet. Home orvnar or Ilcon- <br /> sed agents signature certifies the following: Y <br /> "I certify that in the performances of the work for which this permit is issued, I shalt not employ any person.In such manner <br /> as to become subject to Workman's Compensation laws of California," <br /> Signed .....................••. •------- ---- _ ------------------------------------.__ Owner . <br /> Yitle <br /> ------------- -.- .......--...----.._..-....-. ............... F <br /> (if other n owner! <br /> -",FOR`DEPARTMENTeUSE} ONLY <br /> APPLICATION ACCEPTED BY--------1--t___`...�_.` = DATE ..... S=-y <br /> _.. i <br /> BUILDING PERMIT ISSUED •- -----........ - •-•-------------- ....... ------------------ -- --• -.-DATE .........................<`:...._.......... i <br /> ADDITIONALCOMMENTS -- -•----------------------.......... .................................. .................... } <br /> --------------- <br /> ------------- -------- .... _ --- -- : <br /> -. .....:.. ... . ...----------- ---_ ........................ <br /> ---- ----- - .... --- ... _.._ <br /> ..................... <br /> final Inspection y: ----- •........... ..... . r.._..-...--- ...-..._..._......:...Dote ..... -....._ .-.. ........ I <br /> EH <br /> 13 2L 1-6 v• 5MSAN JOAQUIN IOCAL HEALTH DISTRICT 8/74 3M <br />