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FOR OFFICE USE. <br /> ..................1._.__1�..t­.......................... APPLICATION. FOR SANITATION PERMIT <br /> ............I......_._...••••-- ................ (CompletePermit Noin Triplicate) . ..................... <br /> ......................................................... This Per6it 1!3� Date Issuecl ...�- 7 J <br /> ............... <br /> Pires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health Di�fi`ct for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No.A.,, 41.1 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION .2 ...... ..... CENSUS TRACT............................. <br /> Owner's Name ..._.....__ Phone ...... <br /> .......................... ....... <br /> Ity <br /> Address .................. <br /> �4; .................. ......... <br /> Contractor's Nome ............. ....... ................ .......... ---------_-----------_License Phone VeL�:&v----- <br /> Installation will serve: Residence Apartment House f] Commercial OTr�IIW64ri'llb <br /> IMotel 0 Other.-------••----•-=•.......................... <br /> Number of living units:... 1J I x LA <br /> /____ Number of bedrooms .... i—I-."Sf <br /> Water Supply: Public System:and name ­..' i I iA <br /> . ....... ................ ......... ........ ------- <br /> ---- _- ...................Private <br /> Character of soil to a depth Sand't] Clay,f 3 feet: peat[] Sandy Loom 0 Clay Loom 0 <br /> +44 I.Hardpan 0 <br /> Adobe Fill Material 1...... <br /> ....lfyes,type................ ............ <br /> (Plot plan, showing size of lotj,)�cation of system in relation to wells, buildings, -etc. must be placed on reverse side.) <br /> I rl^ . 4 <br /> NEW INSTALLATION- (No�septic taiiSo_r's seepage pit pe—rmfii;d-it--p-u6ilc—sqwer,�l;s�av-oilable within 200 feet,} <br /> PACKAGE TRE'ATMENL SEPTIJTANK f. .7"o --4C74;`% 1 d Depth ........I.................0 <br /> Size_............ �/' <br /> . .........................�­. Liquid <br /> C&J*itY ----t---•------ Type ......... Material <br /> 4 1%%_,,tI - ------------ ........ No.)Compartments ------ <br /> Dlstance- o nearest: Well ........................... I <br /> .........kundation .......L_ Prop. Line ....................... <br /> LEACHING LINE No. of Lines ....... #------_.-.-•-- Length of each line!.......................... Total Length .......... ................. <br /> V Box ............ Type Filter Material .....................Depth FilterMaterloll <br /> D is nl� to; he�rest! Well .... ........... ...... .............. ..........­......... <br /> Ce I Foundation ------------ Property Line ........................ <br /> I <br /> SEEPAGE PIT Depth Diameter ----- R6ck Filled Yes 0. No <br /> Di ... <br /> Number .--- Rdck <br /> Table Depth-- ------------------------------------------------Rock Size ........ ..........i............. 0 <br /> 1 'D <br /> Distance to nearest: <br /> Well ........................................Foundation ............ ... ... Prop. Line .......................7 <br /> 11 i i <br /> REPAIR/ADDITION Prev.lSanitation <br /> Permit 0 ..............­............................ Dhte ................................ <br /> Septic Tank (Specify Requirements) ­...... . . ...... ... . ... ..........11....... <br /> t I V <br /> Disposal Field (Specify Requirements) <br /> . ..... ----- ---- --- ....... ............ ............I...... <br /> ­--------------------&.............. <br /> % - <br /> I : -:!... . ....... ------ ... ........................ <br /> .......... Cr__L_ <br /> �e::! ----------- <br /> (DrovO existing and requited addition on reverse side) <br /> I hereby certify that I have <br /> prepared this 0011cation and that the work will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and'�Rules-ainci-i-e-'gulatiorivo f the San Joaquin Local Health,,District. Home owner or licen- <br /> sed agents signature certifiez�the following: „LL <br /> "I certify that In the perfor i <br /> mance of the work for which this permit is Issued, I shall not employ any person in such manner <br /> as to become subject to Woritman's Compensation laws of California." <br /> Signed ------------ - <br /> --------- ------- -------------------•-------------•------ weer <br /> By ................... Title ............ <br /> ._ <br /> If other tliah owner) P-J. . ......... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 11 <br /> ................... ............I....... ...... DATE <br /> BUIL*4G PERMIT ISSUED - --- ---- ----------------C........4------(------_1__...d -.,PATE ....... <br /> MMENTS .........-------- ----------- ------------- <br /> ADDITION <br /> ..df414 4_q A.P......... <br /> ZT&I, Ch �Pn <br /> .10�p............... <br /> --------- <br /> Fina -------- --------- ---------------------------- <br /> ,I r1S_,__eCtt_,Ub"y: ........ <br /> p c ion <br /> EH13 2h 1-68 - ---------------------------------- -- <br /> AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />