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FOR OFFICE'OSE; <br /> APPLICATION FOR SANITATION <br /> (Complete In Uplicate) Permit No. <br /> -__..____.-.•-_.-.------------------------•-.. This Permit Expires 1 Year From Date IssuedDate Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549"andexisting Rules and Regulations: <br /> JOB ADDRESS/LOCATION 77 ------- CENSUS TRACT <br /> Owner's Name ... ....... .......... <br /> Address <br /> np&-J* ----•••-•-•-----•........ .......... <br /> Contractor's NameF-- ---- -----..License#JN-5Y --- Phone <br /> Installation will serve; Residence D Aportmenf House,L7iCommercialLt&railer Couft 0 <br /> !".!Notel f-1 Other RPM 6FF1.CF F—Y,1P RN S I 01\/ <br /> Number of living units%.= Nurnbef-of bedrooms-m-_.---.-...Gorb9 e Grinder Lot$lze <br /> C! <br /> Water Supply: Public System and name ----- ........ .........­_­­1­_­_.,­­­............. ......... Private lbe <br /> Character of soil to a depth of 3 feef- Sand'[D Silt[] Cloy F Peat ;k Cloy Loom E] <br /> Sandy LoaM <br /> '­Hordpan 0 Adobe I'lli'Material ASand/0.- If yes,type ...... <br /> (Plot plan, showing sizeoflot, location, of :system in 'relation to Wells, buildings, etc. must be placed on reverse side.) "s., <br /> NEW INSTALLATION: (No septic tank <br /> or seepage pit pe'rmittedtif'public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANKIN, sile_._!' XJJX.4­­------------ Liquid Depth <br /> Capacity Type Compartments <br /> ........... <br /> Distance to nearest. Well ------ ........... . Foundation Prop. Line <br /> I r <br /> LEACHING LINE No. of Lines ...... Length; of each line__A�0_ Total Length ----- <br /> tr <br /> 'D' Box Type Filter Material Depth Filter Material ....... ------------------ <br /> Distance to"nearest: Well -------------....�Foundation Property Line ...... <br /> SEEPAGE PIT D.pth __�..........­ Diameter NumberRock Filled Yes F1 No , <br /> Water Table Depth ........... ...........-Rock Size.-.-.,,,!...............­------- <br /> Distance to nearest: Well ---­........ ............Foundation ....... ...... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..... Date ------- -------- <br /> ...........­_r..1. .....) 0 <br /> bti <br /> I\ : . -_ A- f 7--) <br /> Septic Tank (Specify Requirements) S1RV&7__7MKX—�'_,7V b.>5----^I. <br /> Disposal Field (Specify R�pqumgenis) ._1JEh_4;H----A�INF_ <br /> r,>....-._._.c 6_1.1... ........................ ...... <br /> J <br /> - ------ ---- ....... -------_------------ . .............. -------­...... <br /> ---------- __ ­*.....­ A :� ........__._.......................... <br /> 1376w existing and required addition on reverse side)a <br /> I hereby ceHfy, chat I have prepared phis appflcatlen and that the work will be done in accordance with Son Joaquin <br /> County Ordinal'ices, State Lows, acid ituies and Regulations of the Son Joaquin Local health District. Home owner or licen- <br /> sed agents signature certifies the following; ti <br /> "I certify that in the performance of rhe work for which this permit is issued, I shall'6otr­ play any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed 60 . <br /> ---------­--------I---- Owner <br /> By ------------- ------------- ...... <br /> {If other than owneri 1 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED--8Y--=77-,7-T1 ..............................::...:..1........._............. DATE ----- ;7/.......... <br /> BUILDINGPERMIT ISSUED------ ------...................................................­........... ---­--­---DATE ............. .......... <br /> ADDITIONAL COMMENTS-,,- ., <br /> ............ ---------- ...... - -----•-••--- •-- ------------ ---------------- .. ...... ........ <br /> ............... <br /> ........... ---------- ........ <br /> Final In n by; <br /> 60te <br /> SAN JOAQUIN LOCAL HEALTH DISTRrCT <br /> E.K 9 1-'68 Rev. 5M, <br />