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FOR OFFICE USE: APPLICATION I FOR�SANITATION PERMIT Permit No. _74�m7/01// - ------_'--- - ---- ---- ------ (Complete in Triplicate) --- - ------ --------------------------------- Date Issued -;, f, �11Z %�--- ---------w�__,_� Date Permit Expires 1 Year From Date Issued - ------------------ - ------- 0-0-0 tf'Z-t 0 L49 H I 44-L Applicatidn is here-, �th4cn Joaquin1-ccal.H.ealtK District. for-a,,permit to construct and ins cal the work herein o with Co 7 uinty Ordinance No. 549 and existI99- Rules and Regulations.. described. T* application is made in complian'cie A, -----------------_------- -------CENSUS TRACT -------- ---- ---- J 0 B/A D D 9q/tCATION_�rW ------------------- Owner's Name ------- JVla�_ _J------—1 W-4-al-1_1--------------------------------------6-------------------PhoneF :7:4�6do 14�M..'oe-A-------------- City --- ---- ----------------------------------------------- Address ----------------------- 3-1 -------/ 6e ------ Phone7------- Contractor's Nan ----------------------I----------License # Apartment Housef:] Commercial ❑:DTrai,ler Court :E] Installation will serve: Residence' Motel F-1 Other ------------------------------------------- Number of living units:--.--I----- Number of bed oo s-----3.____...Gqr!?!ag6--Grinder-- -Cot'-Size ----- ---------_---- Water Supply. Public System and name ----- -- ----------------------------_-------- - ------- --------'- ---------- Private X_ Character of soil to a depth of 3 feet. Sand'E] Silt❑ Clay 0 Peau Sandy,Loam ,D Clay Loam El 79 Hardpap F-1 Adobe K Fill Material ------- f yes I, type t------------ -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.' must.be placed on reverse side.) N.EW INSTALLATION- (No septic tank or seepage pit permitted if'public sewer is available within 20.0 feet,) SEPTIC TANK)4 Size------5_'X-FC>- ------- Liquid Depth -:_FY................ PACKAGE TREATMENT Siz ----------- ------ A Capacity 1070 :Type-_f-6-_e- ------- Material No. Compartments ------------- Distance to nearest.. Well 07-------------------Foundation __-!__p------------- Prop. Line = ----------- LEACHING LINE No. of Lines ------3-------------- -Lerigth-of-each .Line------9a- -L.... Total Length -----7Q--- •--------- 'D' ------- -- --- ---------- 'D' Box -----L`__ Type Filter Material A-r1k-----Depth Filter-Material ---- ----------------------- Distance to nearest: Well ------ Foundation --- ...... .Property Line ---.e7-----------11�1k� SEEPAGE PIT Depth --------------------- Diameter ---------------- Number -------------------------!�--- Rock Filled Yes 0 No 0 Water Table Depth ------------------------------------------------Rock Size ------/ \-------------- Distance to nearest: Well ---------------------------------------Foundation............... ---- Prop. Line -----_------_---_ REPAIR/ADDITION(Prev. Sanitation Permit Y# -.-----.------------------------------- ---- Date -----/_-_----------------------=--) Septic Tank (Specify Requirements) --------------- - A ------------------------------------------------------------------I---------- - --------- - -------- ------------------- -------------------------------------------- --------------- Disposal Field (Specify Requirements} ----------------------------- ---------------------- ---- ------------- --------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ----------- -------------------------- - --------------------------------------------------I------------- - ----------------------------------------------------------F----------------------------------- ;(Draw existing_and`re�clulred_adclition on reverse side) I hereby certify that I have prepared this application and that the work will/be done in accordance with Son Joaquin County Ordinances, State Laws,'and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following- _ 711 "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---------- 11 Owner By ....... Title - --- --- -- - -------------------:----------------------------- - -- (If other n owner) F R DEPARTMENT USE ONLY DATE A2 ------------------- APPLICATION ACCEPTE BY ------------------- ----- -------------------------------- - BQfLDING PERMIT ISSUED --------- -------------------. <.--DATE ------------------------------------------- ADDITIONAL ----------------------------------------- ADDITIONALCOMMENTS ----------------------------- ---------------------------------------------------------------- ------------------------------------ ---------- --------------------------------------------------------------------------------------------------:- ------------------------------------------------------------------------------------------- ------------- -------- - -------------------------------------------------------------------- -----Woe-------------------------------------------- 4 % : %- - I�------------- ------ ---- ------------ -------------------- ---- --------------------- --________----.--_________,_-_-- -1\ ''}_--_ ---------- FinalInspection by: --- -- - -- -- - -- - - ------- ------------------------------------- --------------------------------.Date : SA .. OAQUIN-LO.CAL-HEALTH, DISTRICT. r E. H. 9 1-'68 Rev. 5M