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[ON PERMIT 7 <br /> FOR OFFICE USE: APPLICATION-FOR SANITAT Permit No- ---- ----- .... <br /> FOR OFFICE USE.. <br /> --- ------ -- --ju_V!-------- Triplicate) <br /> ------ ------------ ------ ------ (Complete in TO <br /> Date Issued <br /> This <br /> ----------I------------------------------ Permit Expires 1 Year From Date issued <br /> .1 <br /> ----------------- <br /> ------------ ----------------- m construct and install the work herein <br /> n is hereby made to the Son Joaquin Local Health District for a permit to con Regulations.. <br /> App'�ca'io .on is made in compliance with County Ordinance No. 549 and existing Rules and <br /> described. This applicati <br /> CENSUS TRACT -------------------------- <br /> JOB ADDRESS/LOCATIONY-7-6- -------------------Phone ---------------------------- ------- <br /> --10 ---I------------------- <br /> .e -16720---- ....... <br /> Owner's Name ---- -------------------- City ------------ ----------- <br /> Address ---------S__4�vl�q...<:�------------------------------2��----------- License s?ZPhone <br /> ---veow) --—-------------------;-------- <br /> Contractor's Name -----/ rtetll� <br /> Residence Apartment House,0 Commercial;FlTrail&Court Cl <br /> installation will serve. 0 <br /> Motel []other ------------------------------------------ <br /> _ -------lge Grinder Lot Size _4?_d0 <br /> -- <br /> Number of living units:----- ---- Number of bedrooms ----Garbage Private*r <br /> Water Supply- Public System and name lay C] Peat F-1 Sandy Loam 0 Clay,Loam 0 <br /> Character of soil to a depth of 3 feet- Sand'M Silt 0 C <br /> Hardpan E] Adobe`641. Fill Material -_---------= If.yes,type --------------------- --- <br /> Ir . must be placed on reverse side) <br /> (plot plan,.showing size of lot, location of system in relation to wells, buildings, .etc <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> i" f le <br /> ENT J I SEPTIC TANK: Si e_A___,W-9�_X­-,��---------------- Liquid Depth -------- -------- 4, <br /> PACKAGE TREATMENT 6*0rtments ---- ........... <br /> /7 <br /> Capacity Type Material - No. Compartments <br /> . ........ a <br /> Found tion -------------- Prop. Line <br /> Distance to nearest, Well ----gr----------- <br /> ----------------- <br /> LEACHING LINE No. of Lines Length of each line____-q,(:�-------------- Total Length <br /> Le 9 <br /> D' Box Type Filter Materialo <br /> 6 &_OtDepth Filter Material ----------------- <br /> ' <br /> Foundation ----------- Property Line . .... <br /> Distance to nearest: Well --- ----- ----0V No 0 1 <br /> ------ Diameter 123------ Number ----------------------------- Rock Filled Yes <br /> 4 e <br /> SEEPAGE PIT Depth .-Rock Size'/Ar---------------- <br /> e'e-------------------------- <br /> Water Table Depth ---49;; -- ' ..-Foundation ----a9p------- Prop. Line <br /> ------------------ <br /> Distance to nearest: Well ----/1<0 2 <br /> Sanitation Permit# ------- ---------------- ---------------------- Date ---------------------------------- <br /> REPAI!/ADDITION(Prev. Sanita ----------------------------I---------------------------- <br /> Septic Tank (Specify Requirements) ------------------- <br /> - <br /> -------------------------- <br /> ------------------------------------------------ --------------- <br /> Disposal Field (Specify Requirements) ---------------------------------1----- ---------------------------(---- -- ------------------ <br /> -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------- --------- ------ -------------- --------------------- -------------------------------------------------------------------- ------------------ <br /> -------------------------- -------------- (Draw existing and required addition on reverse 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 following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Owner <br /> Signed - -------------- ----- ---------- ----------------- - ------ ------------------ <br /> Title ------- <br /> v <br /> -------------------------------- <br /> (if of r t an owner <br /> FOR DEPARTMENT SE ON1. <br /> DATE r <br /> ATE -------------- <br /> APPLICATION ACCEPTED. B ------ -----------DATE <br /> BUILDING PERMIT ISSUED ­_? _------- -------- --------- <br /> ADDITIONAL COMMENTS - - ------------------ - ------ / ------- <br /> -------------------------------------------------------------------- <br /> ---------------------------I------------------------------------------------------------ ------------------------ --------------------- <br /> ------------------------------------------------ ---------------------------------- <br /> - <br /> ----------------------------------------- ---------- <br /> ------------------------ -------------- --- ------------------------- -'w- <br /> ------------ --------- -- ----- - ___ __ 5- - -------------------------------I---- ------------------------7 <br /> Final Inspection by: ---------------- - --- <br /> ------------------------- -----------------------------------Date --- - ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5Mb <br />