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E-, <br /> ................. <br /> ................ <br /> ThIs Permit Expires I Year From Date Issued <br /> FOR OFFICE USE.- <br /> ��6 <br /> APPLICATION FOR SANITATION PERMIT <br /> ---------------------------•--------- Permit No. -7 <br /> -6 <br /> .......... <br /> (Complete In Triplicate) <br /> .................................. <br /> Doti Issued <br /> .............................. ........ <br /> V <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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..:.....CENSUS TRACT .......................... <br /> Owners NameC-cr........... <br /> I <br /> ........ ............................................Phone l.��.! j <br /> . city .............. ............... ........ <br /> Address ...... ......M.1w T. . of............. ------ <br /> Contracto'r's Name ................. ...................License #S08-OLI-1- Phone .5 11A.9-lb- <br /> Installation will serve: Residince[]Apartment Housed Comme7clat JQTraller Court ] <br /> Motel []Offie,ir ..............—............•...._._ <br /> Number of living units ..... Number of bedrooms ............Garbage Grinder ............ Lot Size .—...... ................................ <br /> Water Supply: Public Syste and name ........................................................-------- .........-.......-­-..................Private 13 <br /> Character of soil to a depth"of 3 feet. Sand 0 Slit 0 Clay 0Peat f-1 Sandy Loam 0 Clay Loam C] 1�3i <br /> Hardpan 0 Adobe 0 Fill Material ............ If yes,type .....;.......... ............ <br /> (Plot plan!, showing size of lot, locdtion of system in relation to wells, buildings, etc. must be placed 'an reverse slcle.)� <br /> I <br /> NEW INSTALLATION: (No septic tank or seepage'pit permitted If public sewer is available within 200 feet,) V <br /> PACKAGE�TREATMENT SEPTIC,TANK I Size----------------- Llq"uid,Depth ........ ....... <br /> T_ '6rtrnents .2 .............. <br /> Capacity No. Compartments <br /> Type <br /> DisiaiiEet6;neorest: Well ......74050=�-- .. 7m...-.Fovndation ../.,5............. Prop. Line <br /> LEACHING LINE No. of Lin Length of each line. <br /> Lines`' .1. ................ Total Length .......................... <br /> 'D' Box Type Filter Material ....................Depth filter Material ..........I.......................... A <br /> Distanceto rest: Well .......--.-..... Foundation ............... Property Line ...................... . <br /> n7ea <br /> SEEP ICE P1IT Depth ................ Number ..........--....... ...... Rock Filled Yes No <br /> ; ir <br /> t FW�ater -T-abie-Depth. ................................................Rock Size ................................ <br /> I Distance to nearest!Well ----------------------------------------Foundation ---- ---- .......... Prop. Line ..............u. <br /> REPAIR/ADDITION(Prey. So niifati&�Permit ............................................ Date ...... ...........................) <br /> Septic Tank (Specify Lkqquirempnts)-�-------------------- .......... .......... ...................:--............................ ............................ . <br /> Disposal Field (Speify Ri�quireirhehft) ------ 4�6---------- .......... ............ <br /> j! <br /> 7 --------------— -------- <br /> -------------•-------- <br /> - <br /> -*--------- -,V <br /> ------ ------- jr---------4 n-n-B./V <br /> -- ------ --V�2 WzV ------ <br /> 4- ��r( 4- qH 1-t ti,r--15, A F3 11 AJ J? <br /> _....... . ------- ---------------- ------------------- VtJ-------a4�P---- ;��Y -r.E --------- .......................... <br /> -------------­-------------- M--- <br /> (Draw-existing and required addition on reverse side) <br /> I hereby iertify that I have prepared this application and that the work will be done In accordance with San.Joaquln ':�: <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local HeaI&DIstrict. Rome owner or licen- <br /> sed agents signature certifies,the following: <br /> .-t� <br /> "I certify that af e work for which this permit is issued, I shall not employ any person In such manner <br /> as to 41\le b to ork an'sC of California. ' <br /> Signed ... ....... ..t:� .............. Owner <br /> I _j --LL— - -. . — - . --.- .. -- -- - <br /> By ----------------I-------- -------------------------------------------------------------------•-•--. --.Title---------------------- ........................................... <br /> (If-other-than-owner). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- -- -------67V 4- N j r-- --------------------- ... DATE ... ------------- <br /> BUILDING PERMIT ISSUED ...... ---------- --------------------- -----------------------------------------------------DATE _.....__.._._.__...........-_._.-----..---r <br /> ADDITIONAL <br /> ............... --------------- <br /> ADDITIONALCOMMENTS ------------------------------------------- -------..........................-....... -------------------------------------------------------- <br /> -------------------------- ------- -------- ----------------------------------------- --------------------------------*------------------------ - <br /> ---------------------------------------------------------------- ----- ......... ........ ...........................------------- ...... .............. <br /> ---------------------------------------------- e��-------- <br /> ------- -- ------------- <br /> ------ -----...-- <br /> Final <br /> ......... <br /> Final Inspection by: ------------------------ --------. Date 7-4�.......... <br /> EH 13 2L IL-68 Rev. 5M <br /> SAN JOAQUIN )OCA EALTH DISTRICT 8/7h 3M <br />