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.4; ..1.11114.1 ••• • 1Draw 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 <br />County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home <br />sed agents signature certifies the following: <br />"I certify that in the performane of the work for which this permit is issued, I shall not <br />as to become subject to Workman's Compensation laws of California." <br />Signed Owner <br />.m p1 oy any person in such manner <br />Joaquin <br />owner or licen- <br />FOR DEPARTMENT USE ONLY <br /> DATE 2 <br />DATE . .. <br />Final Inspection by: Date <br />FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Datelssued <br /> <br />Permit No. <br />Date Issued Issued '7- 76) <br /> <br />4.44- Ale - <br />/ <br />Owner's Name . . <br />Address . .. / a i <br />Contractor's Name ... . y License # I gr3, ).....^.- _ Phone <br />Installation will serve: <br /> <br /> Residenc ['Apartment House 0 Commercial [Trailer Court C <br />Motel 0 Other <br />Number of living units:.....Number of bedrooms .3 Garbage Grinder Lot Size <br />Water Supply: Supply: Public System and. name - <br /> <br /> ....... ... ..._:....... ................. .. .. , .......... ., .Private <br />i <br />Character of soil to a depth of 3 feet: Sand0 Silt (:1 Clay E Peat 0 Sandy Loam fp Clay Loam ,[7] i <br />Hardpan , Adobe jp Fill Material If yes, type <br />IPlot plan, showing size of lot, location of system in..relationwto.wells,..buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seeppge pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT (J SEPTIC TANK . - 'Siz 1.9 /,t4C,C d . Liquid Depth <br />'1 i.i... "‘P.• ,, <br />Capacity /0011/.0 Type .1•7'.7.. <br />,: , <br />:44.... Material :ge)44---,.. ..s ..; No. Compartments A <br />Distance to nea st: Well 50. ' , 'foundation' • I 0 ' Prop. Line ..$ I • , t <br />LEACHING LINE e'r No. of .Lines . ..,,2•• ..... .... Length of each line Ale-0, 0 ° .T <br />• <br />otal Length •2 0 0 <br />'D' Bod..y..... Type Filter Material A 1 • k Depth Filter Material if '' <br />Distance to nearest: Well .5.0 ' Foundation • / 0 ' Property Line X. ' . ....... :.... <br />SEEPAGE PIT ,,,r Depth 1 ...? . .... ' .... Diameter 13 7 Numbe7 .... ar.. Rack Filled Yes <br />Water Table Depth 7.0 1 • Rocl'(Size i'ZA i , <br />I <br />Distance to nearest: Well . .. ..... IPA .. ''„ .... — ..Foun'clatian . ..... /.0..i....:... Prop. Line 4 .1 :I <br />i <br />REPAIR/ADDITION (Prey. Sanitation Permit # :1 <br />Septic Tank (Specify Requirements) ' <br />Disposal Field (Specify Requirements) <br />Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br />described This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> CENSUS :112.ACT <br />Phone <br />JoB ADDRESS/LOCATION <br />—6. <br /> „ <br />.. City ... <br />No 0, <br />Date' <br />By Title <br />han owner) (if other <br />APP_ICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS ... <br />E. H. 9 I -'68 Rev. 5M, <br />SAN JOAQUIN LOCAL HEALTH DISTRICT