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I 4V <br /> FOR OFFICE,USEr, APPLICATION FOR SANITATION PERMIT <br /> Permit No,. <br /> ----- --------------- ---------------------------------- (Complete in Triplicate) <br /> - ---------- L---------------------------------- Date Issued <br /> 4 This Permit Expires 1 Year From Date issued <br /> ----------------------------------------------- <br /> in Local Health District for a permit to construct and install the work herein <br /> Application is hereby reNto-t"cm--J oaq u <br /> described. This application is maA in c6mQ'�Iiance with County Ordinance No. 549 and existing Rules and Regulations <br /> i -yy-------- <br /> S is <br /> . ... ------ CENSUS TRACT ---------- <br /> JOB ADDRESS/LOCATION _301 ------- ------- .................. . 11 1 <br /> -- ---Phoije ------ <br /> -----(far - - ------------T----------------------- <br /> Owner's Name ----- W-e---r <br /> ------------------------------------ City J------------------ ---------- <br /> Aciclre�ss __3_6 -------- <br /> 519--F-------Ow ----------/Zo <br /> ErK000"In 164-jtw ----.License # - Phone <br /> Contractor's Name --------C-44 <br /> Installation will serve: Residence je<partmeAt House,E] Commercial ❑Trailert <br /> Motel 0 Other ---------------------------------- <br /> A41ASA6E-------------- <br /> -)#0,,,5dPb4� Grinders <br /> 1, ur% '81#ible d r&easA <br /> Number of living units:--- ---- Lot Size <br /> Pri a <br /> --- -------------------- -------- <br /> ---------------- <br /> Water Supply: PublicjSystem and-name --------------------------------------------------- ­------------------ <br /> I at E] Sand -im-arn El Clay L <br /> Character of soil to a depth of 3 feet. Sand'[] Silt 0 Clay El Pe <br /> Hardpan ITXciterGl <br /> 'Ad yes, <br /> r <br /> Lf <br /> must be placed on reverse side.) <br /> (Plot plan, showing size-of-lot -lecati n Lf system in relation to wells, buildings, etc. <br /> (No septic tank d se�pa pit permitted if public sewer is available within 20'0 feet,) <br /> NEW INSTALLATION- 41V/ . I I Depth -Z <br /> -- ----- -- Liquid <br /> PACKAGE TREATMENT SEPTIC TANK Size- <br /> Compartments ---- <br /> TypePpF_FA_B_ MaterictI_606(C4XT--- No. <br /> Capacit,' --------- /a # <br /> Line -------- <br /> ------ Prop• <br /> Distance. to nArp's't, Well AV---------------------------Foundation <br /> f <br /> A Total Lenith -----go--------------- <br /> 9 <br /> .,_._Lengt_hof,,Fach line <br /> LEACHING LINE N� Lines ------I-- ------ <br /> Depth Filt?r Material ----- ----------------- ------ <br /> "D Srey)le F i 1Te-r-MMIF1. - --------- <br /> i�istci ------- Property Line ----------------- <br /> 49 <br /> c <br /> f ista ce-zlt*6necir6p.. Well Foundation <br /> Yes No 0 <br /> V L Number Rock Filled <br /> SEEPAGE PIT Depth Diameter `--""------ BOF <br /> Rock Size <br /> Depth ------------- !!Table0' /01, 5; <br /> Foundation <br /> "7N-\Di stance I�to io ........ PrJp. Line ...57......... <br /> near st: Well ------100---------llj-----------Foundat , <br /> )t Date ----------------------------- <br /> REPAIR/ADDITION Sanitation Perml. ---------------------- <br /> 1 . :r ---------------------------- <br /> ----------------- -------y----- - <br /> Septic Tank (Specify,Requirements) <br /> '��r'ev...Sonita <br /> --------------- --------------------7 <br /> -----------------il --------------------- ----------------------------------- <br /> D jj;re1L_1ifN Requ!rements ----- -------------------------------- ------------------------------------- <br /> isposal Field' <br /> 40� ----------------------------------- <br /> -------------- --------J.7 <br /> --- --- 1- 4---------------------------------A <br /> -- ---------------------- 4 ------------ <br /> (Draw Wisting and•required uddition on reverse side) <br /> thafithe'work will be done in accordance with Son Joaquin <br /> I herebyi,certify that Wdve prepared thisapplication and I licen- <br /> sed <br /> f tWl San Joaquin Local Health District. Home owner or <br /> County Ordinances; Laws, and Rules and Regulations a t <br /> sed agents signa '�c frtifies the he followin5i4 <br /> 95 1 <br /> "I cLirtify that in the'y rforrnanee of the work for which this perms issued, I shall not employ any person in such manner <br /> ' tion laws of Cali4rniqr" <br /> as to become sub I le Workman's Com <br /> j <br /> IOWner <br /> - ------ - ------------------------ <br /> Signed - --- -------- - --..:----- --- , <br /> r - 1 ---- i---------------------------------------- <br /> By --- ...... Id-- ---------- _­-------------- -4. <br /> -- -------------------- <br /> er t n owner) <br /> I <br /> FOR DEPARTMENTl USE ONLY <br /> --------------------------------------------------1,7D2AT�EE ---- <br /> ------------------------ <br /> APPLICATION ACCEPTED BY "_.DATE -------- <br /> ED—_­�__ ---------------------------------------=_`' <br /> -------------------------------------- ---- <br /> BUILDtMG-PERMIT-l' ---------------------------------- ---- 4V - ------------------------- <br /> - - -- -- -------------;---!� r <br /> 7 -- -------------------------------------------- <br /> TS <br /> ADDITIONAL COMMENTS _. <br /> -- --------------------- <br /> ----- =__= ------- ----------- -- <br /> ------------------------------------- --- ----------------------- -------- ----- - -------------------------------------------------------------------------- ---------------- <br /> ----- --- ------ -----------------------------------------Date----- <br /> ------------------------------- ------ - - -- ----------------------------------------------- ---- ------- --- ... <br /> Final Insp ---- -- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> '68 Rev 5M <br />