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FOR OFFICE USE. APPLICATIOWFOR SANITATION PERMIT Permit No: Id.-IF?In. <br /> ----•--------------------•----•---------•----------•-- (Complete in Triplicate) <br /> .............I............ sued <br /> This Permit Expires I Year From Date lssuef(!�(a <br /> ----------w�..............................: ......... <br /> r <br /> Appl n is hereby made to the San Joaquin Local Health District for a per'mit to constructandinstall the work herein <br /> described. This application is made in compliance with-h County Ordinance No. 549 and existing Rules and Regulations.. <br /> I -- -4 ENSUS-TRACT-77 <br /> JOB-A-DDR ESS/IOCATION­4!_)� . .......... _Phone <br /> Owner's Name __-110------- h.- selib* -------•-•--•-------....-------..................... <br /> ..............City --- --- - - ------------------------------------•--....--.... <br /> Address ------_101----- ........ --------------------------------------------- <br /> i <br /> License --------- Phone.,...hone.--------------- <br /> Contractor's <br /> Contrcctor's Name ---—_-W_--—---- <br /> Relidence 0 Apartment House-El Commercial:E]Traileir oVrt '[3 <br /> Installation will serve. <br /> Motel C]Other ......... --------------------------- r <br /> ............... <br /> Number of living units.-_Z------ NUmber of bedrooms -..Garbage Grinder ----------- "Lot Size- <br /> e--------Private <br /> WaterSupply: Public System and name ----------------------------------------------- -------•---------------------••------•-•-.--•-- <br /> DO <br /> Char a,cter of soil to depth of 3 feet: :Sond.r] Silt C] Clay C] Peat E] Sandy Loom 0 Clay Loom <br /> Hardpan r­I Adobe-F1 Fill Material ............ If yes,type----------------- <br /> must be placed <br /> I on reverse side.] <br /> (Pl,ot;plan, showing size o�/Idt,—Imbfl-6n of system in relation to wells, buildings, etc. <br /> NEW11SISTALILATION: iNo SePfic Itank or seepage pit permitted if public sewer is available within 200 feet,) <br /> 2 <br /> Liquid Depth -----4!�- <br /> � t7' <br /> TANKDq Size______-- <br /> I <br /> PAC14AGE TREATMENT SEPTI <br /> ...... MateriaI6.0A�.&_ No. CompartmErti—:2.. ........ <br /> I pvcIty 2f- <br /> Distance to nearest: Well .................Foundation *........ Prop. Line <br /> N,8*��*f Lines ..... ---------- Length of each line...------ ---------- Total Length ------ <br /> LEACHING LINE 65 - .1 A <br /> I . I -------Depth Filter Material ----- 1-,q.................. <br /> 'D',' Box ... Type Filter Material <br /> "Property Line --- <br /> to nearest: Well ------ Foundation <br /> I ----- Rock Filled yes 0 No G <br /> SEEPASEE "PIT"' Depth __�7MP------- Diameter Number - I <br /> GE -Rork ........ig-,.1-1 ; . <br /> ---•-•-----••-- <br /> Vater Table Deoh ------------------0 ...............I........ Size <br /> V <br /> llzo Prop. Line <br /> Foundation <br /> Distance to nearest-. Well dation ------ <br /> -------------- <br /> REPAR/ADDITION(Prev. Sanitation Permit --------------------------------------------- Date ----------- <br /> ---------.......... <br /> Septic 'Tank JSpe6fy�RYq_u_,r_ei_-ne_n1_11 --------------------------­ ......................... <br /> Disposal Field (Specify Requirements) <br /> A-------------------------------------------------------------------------------- .........-7-------------- <br /> ........................ ....... --------------------- <br /> ------------------------------I........... <br /> .. ...........................­_­------------------ ------------ <br /> --------T--------------------- ------------- ----------- -- ---------- --------- <br /> I I (Draw existing and required addition on reverse side) -'uIn <br /> I hereby certify that I have propai*d this application and that the work will be done in accordance with Son Joaq <br /> of the Son Joaquin Local Health District. Home owner or lic'ein- <br /> Cou4 <br /> .y Ordinances, State Laws, ciAd Rules and Regulations <br /> sed agents signature certifies the following: s issued, I shall not employ any person in such manner <br /> -I certify that in the performance of the work for which this Permit i <br /> as toibecome subject to Workman's <br /> ' Compensation laws of California." <br /> --- Owner <br /> Signed --------------------------------- <br /> I <br /> ------------------ <br /> Itle ------ -------- ­-------- <br /> BY .... ........... - <br /> (If other than owner) <br /> IPR .DEPARTMENT USE ONLY <br /> ------------- DATE <br /> APPLICATION ACCEPTED BY -- ----- ------------ ............. --------- ------------- --- <br /> BUILbING PERMIT ISSUED ---- -- ...... -------- --------------- -----------_-------- ------------------------ <br /> ..................................... <br /> ADDITIONAL COMMENTS ... . .... .............. . ...........------------------------- ...... ---------_-------------- <br /> ---;,�V...... .... ----------- - -_-------­--------------- ------- -------------------------- ------------------ -----------------_----- <br /> _-_------- ------- -- ----------------------------------------- ---------­---------­­-----------­--- <br /> ........... --- ------------ --------------- <br /> ----- -------- <br /> --------------------------------- --- ---- -- :7�=----=m P, ?�� <br /> ............ .....Date ---- <br /> Final Inspection by: ------- ---- -- -- ------­­----­------------­------ ---------------------------------- <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Re . 5M <br />