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FOR OFFICE-USE: APPLICATION <br /> LICATION FOR SANITATION PERMIT`- Permit No. 70 <br /> - ----------------­---­------ ------ -------------- (Ciollrli_pr— - . - -------- -- -- - <br /> L <br /> ------------- ---------------------------- <br /> Date Issued _i�;;? <br /> ---- This permit Expires 1'Year From Date Issued <br /> ------------------------------- -------------------- <br /> Application is hereby made to the Son Joaquin Local Health-Di stri cbor a per'mit to construct and install the work herein <br /> e, <br /> described. This application is made in compliance Wit County OrdinancNo. 549andexisting Rules and Regulations: <br /> ------CENSUS TRACT -------------- ----------- <br /> - --------- <br /> JOB ADDRESS/LOCATION ------------ ---------- -------- - <br /> ------------ Phone gy(? ...... <br /> C <br /> Owner's Name <br /> -- - ----------- <br /> Address ---- -- ----;;!-�W- ----- ----- ------ --- - -------- ------- --- -- -- -- - -- - ---------------------------------------------- <br /> nse #/ S //------ Phone <br /> Contractor's Name ---- _4 -- --------------- -- --- - ------- e <br /> Installation will serve: Resi nc&PQ Apartment House-F-1 Commercial []Trailer..CqQrt_:E] <br /> Motel El Other---------------------- ------------------ <br /> Number of livinitNumber of beclrodms�,-91"'---GarCa.1ge Grinder---------SI---.,Lot Size -1;1$, <br /> ZWuns:------------ -_ - A � - 1 --1---------Private <br /> Water Supply: Pul�lic'System and name --------------------------- -------- ------------------------ ------------- <br /> 1 4 lq\,� -] I "\, 'NIV - 1i X <br /> Sqndy'Loam �E] Clay Loom El <br /> Character of soil to a depth of 3 feet-. Sand'E] Si It Cl Clay E] Peat <br /> Hardpan E:) Adobe -Yes7type -------------------------- <br /> (Plot plan, showing size of lot, location of system in. relation to to we s,11 buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit,perrnitted"if,public'sWwer is available within 200 feetJ <br /> - ---------•------------ Liquid Depth ---------------- ---------TREATMENT f ] SEPTIC TANK-1rHI, -------------- V\ <br /> Capacity -----------------.�f Type---------------------i Material---- I--------- No; Compartments ----------------- <br /> v <br /> Distance-to-.,nearest: Well ------------------------------------Foundation --------t--------- Prop. Line ----------------------- <br /> 77' )IJ <br /> LEACHING LINE No. of Lines`--_------------------ Length of each line_` ----------------------- Total Length -- --------- ---------------- <br /> 'D' Box ---- Type Filter Material --------------------Depth Filter Material- -----------------------------------.-------•- <br /> -Distance to nearest. Well ------------------=­' -Foundafli� =Property------------ Line. ----------- <br /> SEEPAGE PIT Depth ---------------- Number --------------------------- Rock Filled Yes El No 13-. <br /> Water Table bepth-------------------------------I---------!-----Rock Sizb ------------------------ - <br /> Distance ion ---------------z---- <br /> I I Prop. Line ---------------------- <br /> Distance to nearest; Well ------------:-----------I----------------- <br /> (Prev, Scinitation-P6rmit# -------------------------------------------- Date ------ --------------------- <br /> ♦ L <br /> REPAIR Mcifty Requirements) -------- ---- ------------------------------------,------------vml--- ------------------------------------------------------------------- <br /> I <br /> Disposal Field (Specify'Requirements) ------------------------------ <br /> 4---------------------- ----------------------------- <br /> ­ / ---- ------- <br /> A6-v------ <br /> --------------- <br /> q <br /> ---------------------------------------- -------------------------------------------------- ----------------------------------------------------------------------------------------------------- <br /> i (Draw existing and required addition'on reverie side) <br /> I hereby certify that.-I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State 'Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature-certifies the folkiwing: <br /> "I certify that in the'performance-af:j,the-work for which this.p erm it-is-issued,A sh.a ll-nal-ern ploy-any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------- -------------- ---- ---- ------------------------ ------------- Owner e�, <br /> 1 �� il --! I I %TitIe-'­=-I= 7. ---------------------- ----------------------------- <br /> By -- ------ - - - - --- ---------------------- -- ,------- <br /> (if r than owner) ,{j <br /> FOR DEPARTMENT US 9 ONLY <br /> APPLICATION ACCEPTED BY ----------- ---------------------------------------- ----------- --- ------ ---- DATE --- ------------------- --- <br /> DATE <br /> BUILDING PERMIT ISSUED ------r--------------------- - -- ----------------DATE ---------------------------------1--------- <br /> ADDITIONAL <br /> --------------------------------1--------- <br /> ADDITIONAL COMMENTS ----------------------------------------------------- --- --------------------- . ........... <br /> ------- ------- ----------------------------------------- ----------------- ---------- <br /> ---------------------------------------------------I----------------------- ---------------------------------------------------------------- --------------------------------- - ------------ <br /> -------------------I——------------------------------ ------------------------------------------------------------------------------I------- ---------- ----------- ---------:------ ------­­- <br /> -------------------------- - - ------------- <br /> ----- --------------------- --- ----------------- ------------- -Date ----Or 17-.�6 ---------- <br /> ------ ------ ---- -- -------- - <br /> Final Inspection by� -----------------------------------SAN---JOA-QU-I-N---LOCA-L---HEALTH- - - -Di RIOT <br /> -- --- ------ - - <br /> E. H. 9 1-'68 Rev. 5M 7 el <br />