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iFOR OFFICE USE: <br /> 1712.1 APPLICATION FOR SANITATION PERMIT <br /> -------------- ------------------------------------ ---- <br /> 1�;4 (Complete in Triplicate) Permit No. -70. <br /> ----------------- <br /> n Date Issued 11�7:-ZOn-70 <br /> --------- --------------------------------------- This Permit Expires 1 Year From 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION A X .-------------------------CENSUS TRACT -------------------------- <br /> 0-7 <br /> Owner's Name ----- ------ ------------------------------------------------------Phone <br /> 'A rl"ii� <br /> Address -----VO-214-12-4/----41i,-�_�ovzwxoro------06 rz­�----------- City A14W___1;r 4---------------------- <br /> ripContractor's Name -------727Yo041Y-----------------------------------------------------License #a2S.2.3; Phonelpa_�_,,,,--- ----- -- <br /> Installation will serve: Residence 4-A-Partment House-E] Commercial :ElTrailer Court '.E] <br /> Motel F-l Other -------------------------------------------- <br /> Number of living units:--/------ Number of bedrooms --.:?-----Garbage Grinder Lot Size- X <br /> ------------------------- <br /> / <br /> Water Supply: Public System and name -------- --------------------------------------------------------------------------------------------Priyate <br /> _V <br /> Character of soil to a depth of 3 feet. Sand'k;,;ilt 0 Clay E] Peat El Sandy Loam -E] Clay Loam.0 <br /> Hardpan E] Adobe E] Fill Material ------------ If yes, type -------------- --------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse fside.) <br /> NEW INSTALLATION: (No septic tank or seep pit permitted if p ic se er is available within 200 feet,)PACKAGE TREATAAENT___[.-]'_.SEPTIC TANK:[ Size-.--------------- X'7v-10-------- Liquid Depth __7_0---------i_----- <br /> 00 <br /> CapacitWoZop------ TypeOW- . -7#406- Materialc No. Compatnents_,- X <br /> ---------- <br /> istancelto nearest: Well ----46-to-----------------------Foundation _./40---- Prop. Line J--_--.. 00 <br /> _N 0 <br /> LEACHING LINE d� o. of Lines --..3---------------- Length of each lir)e--'!740---------- ------ Total L th .2-14 <br /> eng <br /> _Vor <br /> 'D' Box Type Filter Material A?r-e-A-1_Depth Filter Material 1-19-A-------------------- <br /> L 11 A� 0 1 <br /> Distancd16 nedrest;'Well-_4�0------------ Foundation .............. <br /> SEEPAGE PIT Depth -------------------- Diameter --- ------------ Number .--------------------------- Rock Filled Yes El No C3 <br /> Water Table Depth --------------------t�n------------------------Rock Size -------------------------------- <br /> -------------------Foundation -----------je------- Prop. Line ----------- <br /> Uj Distance to nearest: Well --------------------- J- <br /> �?)! de ` <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------- ------------ ----------------------- <br /> Date _--_________________;__________-.1 <br /> � <br /> Septic Tank (Specify Requirements) ---------------------------------j----------------------------------------------------I kI-----------------------------_ <br /> Disposal Field (Specify Requirements) --------------- ---------------- --------- <br /> ------------------------------ --------------- <br /> ------------------------------ <br /> -------------------------------------------------------- <br /> -------------------------j---------------------- ------------------------------------------------------------ <br /> -------------------I---------------- ------------------------ ------------------------------------------------------------------------------------------I---------11---------------------- 1> <br /> (Draw existing and required addition on reverse side) # _,6 <br /> I hereby certif [,�i-,gave prepared this apIllikation and that the work will be done in accordance with�ian Joaquin <br /> County Ordincinces,,StaPe Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> c <br /> i 'ie_FA�s.the following:-— <br /> sed ageniii'sUghtiltUre -—D <br /> "I certify that irr"the performance of the-work for-which this permit is,issuedi, I shall-not--employ any person in such manner <br /> I <br /> as to become s6biect to Workman's Compensation laws of <br /> Signed ---------------------- ---------------------------- Owner <br /> ----------- <br /> 4 -6t.Acv- <br /> 00, ---------------- Title <br /> BY ---------- ------ -- ---- ---------------------------- <br /> other than owner) ­zk-_ ,7 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION AC�EPTED BY ------- --------------------------- ----------------------------------- DATE ---- 1:6 - ------------- <br /> BUILDING PERMIT ISSUED-77 -----DATE ------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------- <br /> ADDITIONAL C'0MMEN_T1S ----- ------ ---------------------------------------------------------------------- <br /> ------------------------------------------------------------- ---------------------------- ----------------------------------------------------------------------------------------- <br /> --------- --------------- ----------------------------------------------------------------------------------- --------------------------------------------------- ----------- <br /> -------------------- <br /> ------------------------------------------------ -- ----------------------------------------------------------------------------------------- -------=------- <br /> Final <br /> ------I------- <br /> Final Inspection by- ------------ ------------------ --- --- ------ --------------------------Date -- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> --E.,--H:.9--- 1-'68 Rev.-5M- <br />