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FOR OFFICE USE: <br /> APPLICATION IFOR',SANITATION PERMIT <br /> .......... <br /> ..........i.......­----- ...... (Comploteinfri;l'icate)- -k <br /> .................. Date Issued .4-f"72 <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby m a quin Local Health District for a permit to construct and Install the work herein <br /> 4 grid Regulations: <br /> described. drcompliancewith County Ordinongip No. 549.and existing Rules a* <br /> ------------ ----CENSUS TRACT -----_---------------- <br /> JOB ADDRESS/LOCATI ------- __w- <br /> A 3L.Z"' <br /> ------------------Pho'noe'vP17-1 A.................. <br /> ....................... ...... <br /> Owner's Name7Z <br /> Add Z_v.-----?1r ­.......... ....... .................. <br /> ..........................city <br /> P <br /> Contractor's N.e. ----------_......License# I-OV4 hone <br /> A! 10 <br /> Installation will serve: Residence Apartment House 0 Comirri'ercial oTroiler Court 0 <br /> ortA Motel 0 Otii&�!n'_..........-1.......­­........ <br /> 3, <br /> Number of living unitsi....f..... Number of bedrooMs ... ncle <br /> ...__.Garbage ' <br /> orbage Gfir .............act Size --------- d e.•---•--- <br /> � <br /> rivcrtb <br /> Water Supply: Pub)ic.Systern and"nname ..........n............. ......... ...................... .... ....... <br /> 0 pe6t,n)w-;Scindy-L*M'f5--(-Iay-Loam-B <br /> Zr��r of soil <br /> ........If yes,type.......... ......... <br /> fiiet��ca Aclobeo Fill'm' a Jrial <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> I I L <br /> NEW INSTALLATION: (No-septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT 11 "SEPTIC TANK TI Size........ Depth <br /> .................. ..... Vitluicl, Dept ..... <br /> Capacity .................... Type ---:.-----.--------- M .. .............. No. Compartments .............7, <br /> Distance to nearest: Well —..... .....Founclation .................... Prop-Line............. ....... <br /> LEACHING LINE No. of Lin ...... ----- Length of ea line............................ Total Length ...........;................ <br /> 'D' Box _--------- Type Filter Material ..............t ,.Depth Filter Material ------------.....................__.-T.' <br /> ---------................ <br /> 6,SsW 11 a Lln* ..... ...............00 <br /> "ti.on 1�_..... 4 <br /> Distance to nearest: Well �----------_---....... Founcla ........Zprop y <br /> SEEPAGE PIT Depth .................... Diameter ---............ Number-' ....... Rock-Filledi Yes No, <br /> Water Table Depth ------.1........................................Rock Size •-'<....-_ wr <br /> I Distance to nearest: Well;....._._._...........................-.Foundation __-;_...._...........Prop- ;lino .... ................ <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ...........­...........­.............!­ Date ................................. <br /> Septic Tank (Specify Requirements) ................ ..... ... ... ...... ................. ... ... .......................... <br /> 2 41 <br /> Z......................... <br /> Disposal Field [Specify Requirements) ......._al........ <br /> ..........I................. <br /> -------- o6�i <br /> .................................................. ......... ........................................... ---------------­----- ..................... ............................ <br /> I (Prow existing and required addition on reverse side) rdance with Son Joaquin <br /> I hereby certify that I have prepared this application and-th qt�thi-work will be ci acco <br /> a <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hi'l �' <br /> thDistrict Home owner or licen- <br /> ti <br /> sed agents signatt;re certifies the following: <br /> "I certify that in:the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become' subject to Workman's Compensation laws at California." <br /> Signed ..... .... ... --------------- ---------.......-- Owner <br /> I r. i e�l <br /> By ..... ...... .. .....n- - -- - ------------- ----------.­-Titielj, - ----------- ----------- ----------- - --- ---- <br /> (I oth on owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION - - -- - - - - - DATE J .... <br /> BUILDING PERMIT ISSUEV.......... ....................... .......X�................... -------- ...................-DATE ------------------­-------- ------ <br /> ADDITIONALCOMMENTS ................................. .............. ........... .... .... ----------------------------------- ----------------------------------------- <br /> ----------------------------- ............. .................................. .............._­................................ <br /> .......... ----- -_-_----------------------I...............................----- ------- <br /> ---------- -------- <br /> .......... ...... ....... <br /> ---------- ------ ------ <br /> ..................... . ..... ------------------- <br /> ...__......--.....--.Date -- -------------------------------------- <br /> Final Ihspection by: .... ............ ......... ............ <br /> SAN JOAQUIN Oc LLHPISTRICT.. <br /> _A61j_ Qk UjN_ PtCAkJ11�,.k <br /> E. H. 9 1-'68 Rev. 5M <br />