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' <br /> FOR OFFICE USE <br /> APPLICATION�`I`011t SANITATION PP.014,116- <br /> Application is hereby rn e4o the Son Joaquin Local Health District for a permit to construct and insta he work erein <br /> described. This applicaficin is made I'm n�ce_f it <br /> 0 e, County Ordinance No'. 549 and Isting Rules and Regulations. <br /> ---------------- <br /> Installation will serve: Residence E]Apartme mercial Effraileir Court <br /> °o"". [gu,ne, <br /> Number of living units:----- Number of bedrooms - -;? 'Gm,6age Grinder ----- <br /> Water <br /> -. <br /> VYoterSupp|)^ Pu6|icSyotanon6moma ---.-_-----_'-'-_-!_.-_--_'--'---.__---------.--'Private <br /> Character ofsoil toodepth of3feet: Sand E] Silt Clay Sandy Loom Clay Loom <br /> Hardpan Adobe-E] Fill Material ------------ |fyes, type -_----.---' <br /> (Plot plan, showing size of lot, location of system in relation to wl'�Ils, buildings, etc. must be placed on reverse side.) <br /> NEW (4n septic tank o, seepage p0 permitted if public senr is av?ilable within200 feet,) �� ^ <br /> PACKAGE TREATMENT [ ] Size— <br /> � Liqui6 ��� <br /> Copo6�y � ��` - ^ --�''KA------- ------- <br /> .^���w.a* _ Type .���"��,�'.. . .or�,�|-���/�����@� No. Compartments .-- ��' . <br /> Distnnce to nearest; Well ------- S~* ---------------------Fuundofko-n--_ .4'v--_ Prop. Line --- <br /> LEACHING LINE <br /> LEACH|NGUNE No. of Lines -----Z-------------- Length of each line-- - 74P-10-- ------- Total Length ' r------------- . <br /> 'Cr Box --)� - Type Filter MoFilter Material <br /> ' <br /> ~ �/ - ,_-------- <br /> Distance m��skW�| - �e-.-_' G���ion '-_- Properly� Une '~6�---------_---- <br /> SEEPAGE PIT <br /> --_--SEEPA6EPIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes [] No �] � <br /> VVohs Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to <br /> ----'__--_'Distonceto nearest: Well -----------------------------------------Foundation --------- ---- Prop. Line ......... ' <br /> REPAIR/ADD (Prev. Sanitation Permit#e -.----- ----------------------------------- Date ---------------------------------- <br /> Septic Tank <br /> _----.--_---'--SepticTonk (Specify Requirements) .-.------'-'.----'--.—___'---_-'_-----_.----__-_-.-_-.--''-- � <br /> Dispouo| Go|J (Specify Requirements) ----_-_'--_-_---'-'---_'-----_---'---'-,---'--'-' <br /> '_----'_-_'_-_----_-_------_--'_-'_-----.----'_-'--_-_-_-'_--_--'--'--' � <br /> �~ <br /> /����� ---- <br /> (Dnovvaxishngand required o66�ononn»veneside --- �- <br /> [ hereby certify that I have prepared this application and that the ?vwr& will be 6omm in a««ondammm with Son Joaquin -Y <br /> County Ordinances, Srw«m Laws, and Rules and Regulations of the Smn Joaquin Local Health District. Home owner or Uycem, � <br /> yed mo*nty signature certifies the following: | <br /> ','I certify that in -h <br /> �� - vh <br /> Um permit is issued, <br /> osued. y shall not employ any person im'-w-w-ch- <br /> mammm, <br /> w, b _ of California." <br /> ,Signed ../ Owner <br /> By -----�----'--'-----� ^ -a7s_.-----' <br /> --'------'.�----_- Title ------ --------------------- ----------(� other than owner) <br /> NLY <br /> � <br /> "°.`°=°, ,Em°//V/uuucu -^ <br /> DATE <br /> 40J|Tk]NAL COMMENTS ---------'.'__--__- -__.---.--' ._. -'---_-�JDATE <br /> ---------»�-J-']��'n-- <br /> ----'-------'-'---'------'-----�-'--'--'-------- <br /> ---- --_-._--'--___-__---'--'_'--__'-'--'-_-_.--_.-_-_.-_..----_----' <br /> ---_--_.---. -_'-'-_-_-'------�'_-._.__--_-__'-- <br /> --_ ' ' ' --- <br /> n_spe-c�'--__ . D�/�--�vo �n6y. ��� �__��. __ _ - -'3---------------------------- <br /> SAN <br /> --°---------- -- ---SAN <br /> ���(�U|N LOCAL HEALTH DISTRICT J <br /> / <br /> E. H. 9 l''68Rev. 5M. , <br /> � <br />