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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------i__-.11--------m/0-=?o------- (Complete in Triplicate) Permit N070 <br /> ------- -------- --------------------------------------- - 70 <br /> ---------------- I- <br /> ----------------------- Date Issued----------- This Permit Expires 1 Year From Date Issued ---- -- ---- <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> descilbe'd. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 'D - __V — <br /> JOB AD KESS/LOCATION ,0311------- ....... _aMe <br /> j4r----------------------------------------CENSUS TRACT ---- ----------- <br /> Owr,s, -------- <br /> nle Name ------- ------------------------------------------------------------------------------Phone <br /> Address ------- <br /> le'tce-------------------------------------- city ------------------------------------------------------- <br /> Conthact�or's Name, ./ ----J /� �. _ - --�� s----1.. ---------License # .490-5ll------ Phone _14�J6_AAV.... <br /> Installation will serve. Residence J4 Apartment House,E] Commercial :E]Trailer Court :E] <br /> AAbteI-N.Other--------------------------------------------- <br /> Number of living units------ ----- Number of bedrooms ---,7------Garbage Grinder ---------- Lot Size _111OX-il'o---------------------- <br /> Wat r Sipply:-Publ.ic-Sy..stem-and,name--04 ------------------------------------------------ ------------------Private E] <br /> u -------- <br /> Character of soil to a depth of 3 feet: Sand:F­1 S!± ay <br /> �L_E] Peat 0 Sandy Loom -F] Clay Loom F] <br /> Hardpan ❑ Adobex Fill Material ---I------ If yes,type ---------------------------- <br /> r!o1plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> 1 II <br /> 141EW,INSTALLAVON: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f SEPTIC TANK f J Size_-_--T-A---------------------------------- Liquid Depth ---%e._r------------ <br /> ------------ ------- No. Compartments -_-rte.._-------------- <br /> Capacity P <br /> ------ Type A-4& Aft <br /> Material a <br /> 44 lw <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- <br /> LEACHI GiUNE No. f Lines --_-- ---/----______ Length of each line------tl�!V-------------- Total Length .......11!�_O-------------- <br /> 'D' Box _4------- Type Filter Material Depth Filter Material ____/s6-__________________________- ---- <br /> Distance to nearest: Well -------- Foundation ----- ------------------ Property Line - ---------------------- <br /> SEEP[ PIT Depth —9-S-------- Diameter __.,3SF ------ Number .__1__/________--______ Rock Filled Yes No 0 <br /> I '/ x- 7; 2 Filled <br /> TableDepth ------------------------------------------------Rock Size tl------------------------------ <br /> I i ,�el ------------ <br /> - <br /> Distance to nearest: Well --------------------------------------- Foundation.,-------------------- Prop. Line ------- <br /> -- <br /> IR/ DDITION(Oev. Sanitation Permit# --------------- ------------------------- ,_2pte - -------- ----------- <br /> S+'12Tank (Specify', Requirements) __:------------ ---- -------------------------------------- -- <br /> • --------------------------­ <br /> -------------------------- <br /> DisposalField (Spe/cify Requirements) -----------------------------_ -------------------------- ---- --------------------------------------------------------------------- <br /> ------------------ ------------- ----- --------------------------------------------------- ----------------- ---- -----Z--------------------- --------------------------------------- <br /> ---- --------- -------------------- ---- ---------------------------------- ---------------------------------- <br /> - <br /> .6r.ow-existing-and-requ.ired.addition-on.rLwer e side) <br /> I hereb) certify Ithat I have this application and that .the work will he d-o"ne in accordance with San Joaquin <br /> Counrty Ordinances, State La�;,, and Rules and Regulations of the San Joaquin LocalAHe%Ith District. Horne owner or licen- <br /> sed c!gents signature certifies the following: <br /> X I _1k <br /> "I Ce4if that imthe-performance-of-the-work-for-which-thi s permit'is-issued,.].sh�ll not employ any person in such manner <br /> I y I " <br /> as to beiome subject to Workman'i,'Compensation laws of Coliforn a. <br /> Sign ---------- <br /> �---- -------- ------------- ---------------------------------------- et__ Owner <br /> - <br /> --- --------44t�­ - -------- ----------------------------------9--. , Title .......4e57Z;1e'_44 ------------------ ---- ----------- <br /> (If other than owner) <br /> _#RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------- ----- - -- --------- ----t----------------------------------------------- DATE ---- -------------- <br /> BUILDINb PERMIT ISSUED -------------- - - ---------- -------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL-COI, E�,TSV----7----- --- - ------- ---- -- ----------- ------1-------------------------------------------------- ------------------------------------------- <br /> -- -- --- --------------------------------------------------------------------------------------------------------------------------------------------- <br /> -—---------------- -- - ----- ---- - ---------------------------------------------- -------------------------------------------------------------------------------------- <br /> 1 I <br /> -- ----------------------------- ----------j------- <br /> -------------------------- - -- -- -------- - - ---------------------------------------------------------------- <br /> ---------------- <br /> FinaI1i�1nsP,ectiorj.b*:._._ ------------------------_------------- <br /> CT <br /> N-J.OAQUJ.N-LOCAL-H EA_L.T.H.-QI.STRI <br /> E. H. 9 1.'68(Re/v. 5M <br />