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FOR OFFICE USE. <br /> -2 APPLICATION FOR SANITATIOOERMIT <br /> ----------- .................... 7 7 16 0 <br /> (Complete in Triplicate) Permit No. ....... ...... <br /> ................. to <br /> 3 - 7,7 <br /> ......... ...... ........................... This Permit Expires I Year From Date Issued Date Issued ........... <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 mode in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> ;.. <br /> 1 8 AN, .�Fo.� <br /> DDRESS/L0CATI(. <br /> ......CENSUS TRACT ........... <br /> Owner's Name <br /> ........... ;City...... ................................ ......Phone <br /> Address ........ <br /> .................... <br /> Contractor s Ncime.`:,1�46.41n_ 'j, ense # .7 <br /> ?Phone <br /> -.'� 'Resi 'Pbrtment <br /> md <br /> Installationii e do'.,ncb! House C] CommercialOTraller Court, 0 <br /> . ........................................ <br /> C�cif�66dioor;�s :.:.Garbage Grinder ... --- Lot Size ..... <br /> Numb�r Numbed AAP <br /> r. V <br /> 5u ply:Water Publioy System and d r�arne <br /> . ... ... .............................. ........................ ............___.......... rivat <br /> Char6t1fer':o'f-s'oi I'fo' ,i3`dbpth of 3 feetSend '; Silt Clay [D Peat E] Sandy Loom 0 - Clay Loom E] <br /> at n Adobe o Fill Material ........ <br /> If yes, F <br /> ................ <br /> {Plat' <br /> ocafi0n�kb' tystem -in relation to we{ls, buildings, etc. must be placed on reverso� side.)., <br /> ' <br /> pj ani showiiniq'��iza of lot, I ` <br /> ,NEW INSTA'LLATION;,, (No sepil'C"fo' n".k., page pit permitted If public sewer is available within 200 feet, <br /> ;-X/o X J/1VV <br /> PACKAGq,TREATMENT SEPTIC TANXf] '0094. Liquid Depth ........ <br /> ee 04 <br /> Capacity . ......Type .1�. �;e�Materiol Vo. Compartments <br /> Distance.,to',-.nearest.- Will ��__Foundotion .•__/.P---------- Prop. Line .."�. <br /> LEACHING IINE No. of Lines —----------- Length �of'each line.__. ............ Total Length ..... ......... <br /> 'D' Box !-...... ........Type Filter Material __147441'K.Depth Filter' Material ........1.1 <br /> ---------- <br /> e to`nearest: We <br /> c . - i f/n­ -..*.. ......... <br /> ounclation ....../.�� Property Line ---- <br /> ZO <br /> SEEPAGE PIT Dej�ih ❑.�-------- Diameter ....... Number .......................... Rock Filled Yes C] No ED <br /> -A -4 <br /> Wotdr,'Table bep' t'g, ....... ........... ...........................Rock Size ........­­........... <br /> Distonce-to nearest, Well ......... ........I--------------------Foundation --- ................ <br /> --------------- <br /> REPAIR/ADDITION(Prev.-Sanitcitioh'Rermit. ------------------ Date .................................. <br /> ...... ....... <br /> Septic Tank (Specify <br /> ------------- ............. ...................... --•--•......-•-•••......--.w...... ... ............... <br /> Disposal Field (S ecify.-Reqviremepts) '.'.,­............................... --------------------------------------------------- ......... ....................---------- <br /> ........... ............................................__---------------------- ----------------------------------------------------------------------- ..............I--------- <br /> ................. .......... -------- --------- ----------------- ­---------------------------------------- .......... --------..........................._------- ------ --------- <br /> .(Draw existing and required addition on reverse side) <br /> I hereby certify-that I h4,v#-prepbred this application and that the work,will be done in accordance with tan Joaquin <br /> County Ordinances, State LaWs,",aiscl. Rules and Regulations of the Son Joaquin loctal Health 'District. Home owner ar!:Iicen. <br /> sad agents signature cer"tifie"i th614)116wjng: <br /> "I certify thatin the perfrm <br /> -of`t'".work for which this permit is .Issued, I shall not employ any person in such manner6ah`i . <br /> as to become su6i6ct to W' *rk,rn`ah!s Compensation laws of California." <br /> Signed ......................... ......L ........ <br /> ..........._................. Owner <br /> ------------ <br /> B ---------- ------- Title ........................... .......--------------- ....... ....... <br /> (I ,ther W6)j'lhowner) <br /> -fiOR DEPARTMENT USE ONLY <br /> APPLICATIONSCCf PTE6..-6�7., ... ........................ <br /> .... ....... ................ .................. . <br /> ........... ........ <br /> .0" <br /> DATE ............ ....... <br /> BUILDING, ISSUED <br /> PEgMIT3, ,k._...'_.` <br /> e ---- ...... ...............................DATE ........................................... <br /> ,ADDITIONAL COMMENTS N', -------------�­' <br /> ......... .............­-- -- -----------_-­-------­­­:..............i­­......... .................... .. <br /> ............. ­,.�­.%­1................ ...........I..................... <br /> ....... ---------------------------------------------------------------------------- <br /> ................... ....... ...... ................. ........ ............ <br /> ------------------------------------- ................. ............. ......... <br /> ................ .. ...........I...................... ................ ............ • ....... <br /> ... ....... ..... ........ --------- <br /> Z <br /> Final 1ns0efcfl'6'6'1b­-,` ----77... <br /> .. ... ..................... ... ................ ..................................................Doi' <br /> ... .................. :1..---•-- <br /> l <br /> :yy <br /> 1.1,4, 711 SAN OAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 24 1,. <br /> 7/77 q i'I <br />