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FOR OFFICE USE: '`' <br /> V APPLICATION FOR SANIT:,710N PERMIT FOR OFFICE USE: <br /> 6 <br /> Permit No. -A�•,-•. <br /> (Complete in Triplicate) /�� � <br /> Date Issued—............. <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 described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations <br /> JOB ADDRESS/LOCATION y iJ A'L!/`'Y+ . ..................••••••• •CENSUS TRACT.................. ....... ... <br /> Owner's Name f0- d•�J7 Phone . ....................". .. ..•... <br /> ..... .............. .. <br /> Address C'�� lri . ................Phone Zip........:..... <br /> City ......... ..... <br /> Contractor's Name 1 licensee P •a� �� % <br /> Installation will serve: "Residence ❑ Apartment House ❑ Commercial ❑ TrailRr Court ❑ <br /> Motel [) Other <br /> Number of living units: ! Number of bedrooms. .. Garbage Grinder........ ...Lot Size.. .IO 6'C/I ,�.• • - <br /> Water Supply: Public System and name ....Private <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay❑ Peat❑ Sandy loom❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ rill 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 side.) n' <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ls' <br /> PACKAGE TREATMENT ( ] SEPTIC TANK ( J Size IV y ' .x �•0• Liquid Depth .�....- - ^. <br /> Capacity/ No. Compartments ... 1C' <br /> �QL�... .Type � Material . ,li�-. _... P /"�....... . . ... .. <br /> / © Foundation .. Prop. Line . . <br /> Distarce to nearest: Well.. .`. <br /> LEACHING LINE ( ] No. )f Lines length of each line .. <br /> - . Total Length/ 0 - ...... <br /> ICA <br /> 'D eox Type Filter Material Depth Filter Material J <br /> .. .....dt <br /> Distance to nearest: Well... ...7L' Foundatiotl...................... Property Line . <br /> SEEPAGE PIT ( ] Depth 1' Diameter ...q'),.�r�..Number ... ........... <br /> ................. Rock Filled Yes❑ No <br /> _ . ..__ <br /> Water Table Depth......................... . . ................ . ..Rock Size. � � .. o <br /> Distance to nearest: Well.. ...... <br /> �. ..........Foundation . /�O Prop, line. . <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.................... <br /> Date. ........... ) <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) - ......""""""""""""". <br /> .. .... .. ......................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County <br /> Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> ich this permit is issued, 1 shall not employ any person in such manner as <br /> "I certify that In the performance of the work for wh <br /> to become subject to Workman's Compensation laws of California." <br /> Signed.._ Owner <br /> Title <br /> By.... I o er <br /> thciownIITV <br /> FOR EPART ENT USE ON Y _ <br /> ---- ----- — <br /> r//L`opt <br /> APPLICATION ACCEPTED BY DATE f DATE <br /> .......... ... <br /> DIVISION OF LAND NUMBER <br /> ADDITIONAL COMMENTS / <br /> ,.��1� ..,.�.o. .e/ /el .�/< . 6. .... ......... <br /> w.,�> 7cG /. . .......... ..................... . <br /> Final InsPec*lon by: /� wl--lj.... . . Date <br /> r&S 71677 REV 7/70 3m <br /> [H 13 24 SA JOAQUIN LOCAL HEALTH DISTRICT <br />