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e F <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, <br /> ......... .............. ... (Complete in Triplicate) - I <br /> --­--------­---­----- .......... Date issued <br /> From Dole Issued I <br /> This�Permit Expires I Year Fro <br /> ............. ..... ............... <br /> d install the work herein <br /> K. -ihir;b�lmode to the Son Joaquin Local Health District for a permit to construct on. <br /> Application is a lei and Regulations: <br /> This application is made in compliance with County Ordinance No. 549 and existing Ru <br /> described. <br /> NQ <br /> !�Z ...... 5 <br /> ......... .....CENSUS TRACT .... . ........ <br /> JOB ADDIRESS/LOCATION ----7 <br /> ............Phone ------------------------------------ <br /> Owner's Name .......MAR RIX._ ........ J_KJq-S___........................ A <br /> -0 city _,_q...... ......................... <br /> ....... .....EzC <br /> 5 Z<2............. <br /> Address .......J/j -I --- . ... ... <br /> Contractor's Name ...........................------- .........:........Lire cense# ----- ---r----- -------- Phone .............................. <br /> Installation will serve: Residence artm4nt ouseCommercial 10Trallet Court 0' <br /> :�McLl E]�Sher -------_-------------........... <br /> Inderx"tS., Lot Size AMjFA&-1F—------­----- <br /> VgStoorns,.'�O .Gorboge Gr <br /> Number of living units:...... ._... =Ur of <br /> id name .---------------/.11.......................... ......... ... .........:Private <br /> Water Supply: Public System an <br /> Clay Loam.0 <br /> Character of soil to a depth of 3 feet- Sand O/Slit 0 Clay C3 2Sandy Loom <br /> peat <br /> eriol -k0ge If yes,type ..... ....... <br /> Har,cl-ptin E] Adobe C] Fill Maf <br /> b� placed on reverse side.) <br /> location of system in relation ta-wells, buildings, etc. must <br /> (Plot plan —ii�-Oi lot] o I V <br /> showing s c 'is available within 200 feet,) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer i <br /> S I! <br /> PACKAGE TREATMENT I I SEPTIC TANK-T I ize....... .......... .................. Liquid Depth .........•--_------••-- <br /> i <br /> Capacity <br /> ........ --_----------- <br /> capacity --------------- %.. Type ----- ---------- - Material.....--_..:........... N Compartments ---------------- <br /> Distance to nearest: .........Prop. Line............ ..nearest: Well ............_.......... ____._...Foundation ......... <br /> Length of each,line.........I!...... ......... Total ?ngth ................ <br /> LEACHING LINE No. of Lines .... ------------------ <br /> Mat ria) <br /> _------------------------ <br /> A------------ Type Filter aterial ............ ...Depth Filter <br /> Yea U] Na <br /> 'D' Box ..--------.- 'A�.......... ... Pr4irfy Line _._.........__._..:--- <br /> SEEPAGE <br /> ---............. <br /> Distance to nearest: Well ................... Foundation _ <br /> D.epth ................ Diam r _............. Number .................. ...... Rock Filled <br /> ❑ <br /> SEEPAGE PIT ....... ....... <br /> Water Table Depth ......7 ..................................Rock Size ........... ..... Z <br /> Distance to nearest: Well - ---------t..... Foundation ----- ...........xProp. Line ...................... <br /> REPAIVADDITION(Prev. Sanitation Pe7rmit#...... -Date ............. ............ <br /> ...f............................ <br /> .................. <br /> Septic Tank (Specify Requirements) ------­------- ... ......... ..... ......41....... <br /> Requirements) ......AW-----_A00r. 1• <br /> P7 _=........ <br /> Disposal Field (Specify <br /> 7 .. .... ................ ....._..M..................... <br /> 'M <br /> ----EXV�in <br /> ti. ............ ---------------- --- <br /> .............................:............. <br /> -------------- <br /> ............... ...................... ..........(Draw existing lions <br /> onde)J.I - rk 11 be done in accordance with Son JcffquinI hereby certify that I haveiprepared this application nd that the wo wiCounty OrdinancesF State La s' andRules and Regulaof the San Joaquin Lo X cc 3 1 Health District. mama owner or licen- <br /> sed agents signature certifieNhit following: <br /> "I cerci he perFo *work for which this permit is issued, I shall not employ any person In such manner <br /> in t if ",c a t, <br /> as to be. sub ect t %,f compensation laws of California <br /> ......................... Owner <br /> ... ...............I...... <br /> Signed y-N <br /> -MR-4)........ Title . ........ ......................... ...........­ ---------- <br /> By ............ ........................------r.... .......... ............. <br /> (if other than owner) <br /> poR DEPARTMENT USE ONLY _4 <br /> DA71 i -r� <br /> E 0. ..... ----7-=--7. ... <br /> APPLICATION ACCEPTED BY VX-­L%*1- DATE I.,. ...... . <br /> BUILDING-PERMIT-ISSUED-r. <br /> AK:A -J. <br /> ADDITIONAL COMMENTS ........ <br /> ............. <br /> - ... <br /> Final linp4i ........... . <br /> -'- .. ... <br /> SAN JOAQUIN LOCAL HEALTH*:,DISTRICTS <br /> E.H. 91 '68 Rev. 5M <br />