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FOR OFFICE uoc APPLICATION FOR SANITATION P ERMIT � <br /> a (Complete in Triplicate) <br /> Date Issued ­? <br /> Application is hereby made to the San Joaquin Local HeAh D��­�Ict for a permit to construct and install the work herein <br /> desFribed, This application is rridde in compliance with County Ordinance No. 5A9 and existing Rules and Regulations: <br /> -05ery -&,,----P---X---------?4--4------------------------I--- Z­------------- F <br /> Motel El Other <br /> Ad <br /> Character of soil to depth of 3 feet: SandV Silt Clay E:] Peat E] Sandy Loam E] Clay Loam E] <br /> Hardpan F] Adobe�E] P7U Material -------- If yes, type ------------------ --------- <br /> (Plot <br /> '_<Plot plan' showing size of lot,'location of oyuoum in relation to ",eUs' buildings, etc. must be placed on reverse side'.) <br /> NEW INSTALLATION: (No septic tank o, seepage pit pp,m|Ma6 if-public ue,ve, is available within 280 feet,) <br /> PACKAGE TREATMENT [ ] SEPT|CTANK{ ] Size--.-�� X -- Liquid Depth ------------- <br /> M <br /> -`-- - <br /> ' ��«�� | �� ,- <br /> Copocty .������-_. Type '��r-.-�«n�'N\oterio .�W�/�6����.� N�. Cmmpo�,ne�� ."=�--------- <br /> Distance" <br /> --D|nxzn ` to nearest: Well --6- --------------------Foundation --/-49./--. Prop. Une '��'...-_-.- \} <br /> �� ` ~�.�r ���x� ' �-- <br /> | <br /> LEACHING LINE [ ] No. of Lines _xr�-----' Length -'~r*r.---- Total ..r�c��---'--' U*~� <br /> | <br /> -^D' Bux1__-' Type Filter Nhoha'o|~�»� ' -----Depth Filter Material ------------------- <br /> --------------- <br /> Distance <br /> ----.. --_--Dimnnce to nearest- Well .. ---' Foundation -Jy.�L'"------- Property Line '49.................. <br /> � <br /> SEEPAGE PIT Depth ------------------ Diameter ---------------- Number ---------------------------- Ruck Filled Yes C] Nm�0 /r <br /> Water Table Depth <br /> --------------------------- -------------------Rock-Size <br /> ------:-------------------------- <br /> Distance i <br /> --_'--__':to nearest; <br /> '| Well --------------------------------------- Foundation ------'' Prop. <br /> Lin-- ------'-'-- <br /> ,�- <br /> . --- (Prev.Pmv. SanitationPe,m # ' ' DoYa ---------- <br /> Septic <br /> ' - 1 <br /> SepticTonk <br /> (Specify R�qoinar��ma} ------_---------------__---_.--__-'-__---_-----. <br /> Cxsp000i Field (Specify Roq -'___'_--'-_-_--__.---___--.---�'-'----'`-'' <br /> | <br /> ------_'-.-.--_----.-'-_--------__-'_-_.----_-.--__-'_^_-'-.-' <br /> --------------------------------------------- -------- <br /> , <br /> � (DrawemisNng and required addition on reverse side) <br /> ` | hereby certify that | have prepared this application and that the work will be done in awwmm6amcm with Son Joaquin <br /> ` <br /> ^ County Ordinances, State Laws, and Rules and Regulations ��f �h� �wn ����u|m ����y ���VY� District. Home owner or licen- <br /> sed agents signature certifies H`eifollowing: ' <br /> ^'I certify that in the perfo,nmanc�_ofthe work for which this permit is issued, U nMa|| not employ any pmrwmn in such manner <br /> as to become subjectv Wkc ' Compensation laws of California." <br /> Signed -.-.-----' Owvno, .. <br /> By ------- Jitlm ------ --- --- ----------------------- '_------- <br /> '. _= ~."" °""= <br /> � <br /> ^ <br /> --------------------- <br /> � i ------------------------------------------------ <br /> '- ' ' -------'-----'--'—' <br /> � --------'------l --�---------'---'- ------------------------------------------------------------------------------------ <br /> ----------------------------------------------------- --------- �������---�----�---����������������������� <br /> -.----_--.--. -.-.---'-_.-----__---'--__- -_'--- <br /> zr <br /> Final Inspection ---.-��r����'����?��z=�.---.-------------------Do�e -��.-��������,--_ ---- <br /> SANJOAQU|N LOCAL HEALTH DISTRICT <br /> � <br /> �� �_~E. H..9 l''68Rev. 5kA~__ . <br />