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FOR OFFICE USE: APPLICATION FOR SANITATION. PERMIT <br /> /0.'3c> — - <br /> ...................... ............/ <br /> - ,. ]1. - (Complete In Triplicate) Permit No. ................ <br /> .......................... ............ ....... <br /> -......76. <br /> -this Perm It Expires I Year From Date Issued Date Issued . <br /> .................. ............ ........... <br /> Application is hereby mal 0 to the Son Joaquin Loco[ Health District for a permit to construct and Install the work 'herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> is <br /> JOB ADDRESSAOCATION ............4a./�.�Ove N........ .'................CENSUS TRACT ......__......... <br /> Owner's Name ... ......... .........P <br /> .. ........­... .......................Phone ..... .20------ <br /> Address ........... 2_ <br /> ........... ...........City -_...... <br /> Contractor's Name ---- ------ License # .7L.,5-VJ.7__K__ Phone <br /> Installation will serve: kesiclence3g Apartment House 0 Commercial OTroller Court C] <br /> Motel (:)Other .................. ........ <br /> Number of living units.---I Number of bedrooms ....�1....Garbage Grinder ........._ Lot Size <br /> Water Supply. Public System and name ................................................... .......... ............................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 silt 0 Clay 0 Peat[J Sandy Loom 0. Clay loam <br /> Hardpan 0 Adobe 0 Fill Material ......I—— If yes,type ............... ............ <br /> (Plot plan, showing size sof lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: -(No-septic-tonk-or--seepage,.pit permitted-If public sewer is Available within 200 feet,} <br /> . ............ Liquid .......... <br /> S i i&�LSS x-.,;_,Sl,A././_.. <br /> PACKAGE TREATMENT SEPTIC�TANK);d----7Depth .....4:�� <br /> C opacity <br /> .02P4492-5No,Compartments ......... <br /> D; -Y 5................Foundation on 0......... Prop. Line ....�2_4P <br /> !stance to nearest: Well --- oti .......... <br /> LEACHING LINE No. of Lines' of-each line.._. ........ Total Length I X(2'........... <br /> 'D' Box O'er. Motoriol .... .............. <br /> Type I ........Depth Filter Material .............e��, <br /> Distance to nearest: WellProperty Line........ ............... <br /> 1M Foundation ......_tea.'__....-. <br /> 11 # W�d 7— N.'. <br /> SEEPAGE PIT Depth ------- ..... Number .......:'�_........... Rock Filled Yes No 0 <br /> Water TOW Depth- -------3eO -Rock Size _-•---x.1.............•-- <br /> ................ <br /> Distance to nearest: Well ......IY,6Y�K_S�!..............�..Foundation ....�/g........ Prop. Line .......... <br /> # --------....:.............•__- Date -------•--._:__......-- ..........I <br /> REPAIR/ADDITION(Prev. Sonitation-Permit <br /> Septic Tank JSpecify ReqIM uirements),,__�......................... • <br /> ............. ------ .............. ........... ............................................................... <br /> Disposal Field fSpedify. Requirem6nts) ............................... --------------------------------- .......... --------------- F-------...•..---..... <br /> ------------_------------_-- -------------------_- ............................................... .............. ---------- <br /> -------------------------------------11 V_-------------- ... <br /> ---------------------------------------I ----------------------------------------------------------------------------------------------------------------­..................*.................... <br /> (Draw existing and required addition.on reverse side) <br /> I hereby certify that I have prepared this application and that the wAork"will 6 done In accordance with Son Joaquin <br /> County Ordinances, State 1�aws, and Rules and Regulations of the Son Joaquin Local HealOWDIstrict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work-for-which-jhis-p-erl <br /> imitJsJssued -sholl-not-emplay-any person In such manner <br /> astobecome subject to Workman's Compensation laws of California." <br /> Signed------ - ---------1C.4--`5•---- -- --------- Owner <br /> By ........ .. 5S -• ...................... Title .............................. ............ ..................... ...... <br /> (If other than" owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> -------- ----- ­ ........................... -- ----------- DATEa,"............ ......... ...... <br /> BUILDING PERMIT ISSUED --- DATE ------------------------------------------ <br /> , <br /> ADDITIONAL COMMENTS -....-----•--••-•------.... N.------------------------------- <br /> -------------------­......................................... <br /> .............. ...............1M-------------------------------------- ---------------------------------------- -------­----- ............ ------------------------------------- ------- <br /> --------------------------*---*----------------*------------------------6.............*--------------------------------------------------------------- ----*----------------------------------------------- <br /> ----------------- ------------­.... I__ . ... . .......... .............................. .............. .......... ........... --------------------- ---- -- t.................... <br /> Final Inspection by. <br /> ......................... ........... .......... .................................. <br /> Date ................................... <br /> EH 13 24 1-68 (HArel 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />