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— I ;k 414ftl <br />FOR OFFICE USE: <br />APPLICATION 00i SANITATION PERMIT <br />. ...... . .... ................. <br />(Complete In Triplicate) <br />... . ........ -- ........ . .............. <br />This Permit Expires I Year From Date Issued <br />Permit No. <br />Application is hereby made to the Son 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 and existing Rules and Regulations; <br />JOB ADDRESS/LOCATION ......... . .... MSUS TRACT .......................... <br />Owner's Name ..... ........... . . ................ . .. ... .................Phone AW5- Ck'4'.. 1 (o <br />........ <br />Address...... — city ........ . . . .. . — ............... - ...... <br />.. . ............ ..... <br />Contractor's Name............. -................License # phone ------- <br />Installation will wvs. —Rosidemen Apartment House f_] Commercial ClYraiter &rt <br />Motel rl Other t. .......................... <br />Number of living units:. �0.. Number ofjb*%rooMl; 04) .... Garb9,9e Grinder AC)..... Lot Size .11A...' 1'5 <br />Water Supply: Public System and name <br />Character of soil too depth of 3 feet: Sand] Silto Clay[] Peatl7l SandyLoarrit CloyLoom o <br />Hardpan C] Adobe 0 Fill Material If Yes, type ....... <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, ek. must be placed on reverse side.) <br />NEW INSTALLATION. (No septic tank or see§agw— it permitted if,public sewer is mailable within 2W feet,) <br />PACKAGE TREATMENT X SEPTIC TANK I &�74%!Size. Liquid Depth <br />Compartments ........ <br />Distance to nearest, Well Prop. tine. <br />LEACHING LINE No. of Lines Length of obch lime...__.............._......_ Total L*ng* <br />1, ­a'l <br />V Box M <br />Type Filter terial --A.............Depth riltJl mcdolrial � ........ . ........ . <br />Distance to noor,e,st: Well Foundation ... Property Line ....... <br />SEEPAGE PIT j j Depth .... DiametersNumber .... Rock Filled Yes o No C3 <br />Water Table Depth ............. ��740 : <br />................. ... . ...... Rock Size ..11 ......... <br />. <br />Distance to nearest.. Well ....... ---..Foundation PVW Lb* _...__..._..._.w... <br />RIEPAIR/AD611TION(Prov. Sanitation Permit# — .....4;...., . , Date .......... ------- <br />Septic Tank (Specify, Requirements) ...... ...... --------- ....... <br />Disposal Field (Specify Requirements) ........... ................... <br />.......... ...... ...... <br />............. ................ .............. <br />(Draw existing and required addition on revorso side) <br />I hereby certify that I have prepared this applicaMon and that the work will be do"* In utcoMcneo with SO" Joaqutn <br />County Ordinances, State Laws, ana Rules *tW 1111gutegoris of the Son Joaquin Local Heahh Distirld- Mom* **VW Or licen- <br />sod agents signature certifies the following: <br />"i certify that in the performance of the work for which this permit Is i"U4 ; Awl not topiloy any Parcae in suds Manner <br />as to become, &vbj*g,1 to W an's Compensation loft of Californila." <br />Signed Owner <br />. ....... ..............................................._-_._...__.Title.. <br />(if other than owner) <br />F09 VEMATMIENT USE OWY <br />- ------ . .. oxm 7V4F41 .... ............ - <br />APPLICATION ACCEPTED ........ ....... <br />BUILDING PERMIT ISSUED ......... — ............... ----- - -- <br />ADDITIONAL COMMENTS.4' ............. -11--- . .... <br />---------------------- ----------------- ......... ^ ------ <br />- ----- <br />----- * --------------- ­­ ...... <br />..........................`�,� ¢V :: .......... .......... <br />. ... .......... <br />Ian <br />�::`.... <br />............ ...... ...... <br />Fi <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />r. <br />E. K 9 1-168 Rev. 5M <br />