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FOR OFFICE USE: /��e' �---•_ "— <br /> ;.._.._....._. `-- A►/UGTION FOR SANITATION �ERM{R <br /> _............I-. <br /> .. ...._..�.........:..... . - ICC4MpW*In Tripllcatei Permit N0.227.f.-)22. <br /> _-........................................._ This Permit Expiresi Year Rem Date issued Date Issued 3,1 -..77 <br /> Application Is hereby mode to the'Son Joaquin Local Health District for a permit to conatnict and install the work herein <br /> desaiiied�l�ia ppli /oq Ef made In compliance with County Ordinance No. 579 and existing Rules and Regufations, <br /> JOB AjD,ORE(PSS/L /CKATIbN �f,SjTja.f'-,4w,!�...�/pE Ycna� PY- .of,Q"AW « vo, Mons .cr..i <br /> ._, . <br /> . .........I............................ ...-n'tEN 5 TRACT .........._......:...__._ <br /> Owner's Name , --,-.-•-r¢or+Nf•.•�O- dX. _ �abv_ r-/�PminPl�T'••r <br /> �iYs YrY �................ .. .. Phone .. Y.'.. . <br /> Address Z�f-a?/ j <br /> Contractors teams............. ..............._.............._......_. <br /> ..._»`»__._._.._....__.__................._......................... 1E ............. Alone Installation will serve, <br /> "'""'" " ............. -` <br /> Bisldertae O Apartment Houwt] Cmordal Mailer Court Ej <br /> MOM Ci Other ra.rr W e l <br /> Number of living units:....../-.._ Number of bedrooms ......Z.-Ga <br /> rbage Grinder ............ lot Size ---•- <br /> Water Supply: Public System and name . ............ <br /> - <br /> ....................-------------.._..._....._,. .Private �( <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ($: POW - •----•-»^•,--.-•- <br /> O Sa ndy Loom p Gay Loom O <br /> Hardpan 0 Adobe 0 Fill Material ............'If yes,type............... . <br /> (Plot plan, showing sire of lot, location of system in relation to wells; buildings, eta must be plated on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,t i <br /> PACKAGE TREATMENT 1 ) SEPTIC TANK <br /> Size....... .........................�1. ........... Liquid Depth ....�.�. <br /> capacity �/a2tICJ-..._ Type�re.�,r�.. Material.Gntr..clt... No. Compartments v <br /> .� <br /> Distance to neoresh Well ..- ...................Foundation Foundation ....../A--------- Prop. Line .. ._:._..... <br /> LEACHING LINE No. of Lines .......... ........ _.- Length of each line...... <br /> 1 .... Total Length <br /> 'D' Box .....1..... Type Filter Material sn %- 2- F/�De v <br /> / Depth Filter Material __..../9......._...�;.._ . <br /> P <br /> Distance to nearest: Well ....... .QO........ Foundation ...... Property Line ...5...».. <br /> `SEEPAGE PIT Depth < `� n _. �Q••-•--•••-� <br /> I <br /> ,�5._-..-- Diameter ...3�....... Number ............... t!.»1�.t_ Rock FiNed Yet �PIo <br /> Water Table Depth ..._.....,:t [��•...- .._.. .-Rock Sire Gi... !c k <br /> / <br /> Distance to nearest: Wall _..... -a-..... _......... size <br /> .-......... ... Prop. Line ....... <br /> .... <br /> REPAIR/ADDITION(Prev. Sanitation Permit$t „• Date ........ <br /> Septic Tank (Specify Requirements) ........... r <br /> Disposal Field (Specify Requtroments) <br /> _-_-._•--..........................._....... ...................... <br /> _.........................__..-_...._.•-••-•-•---................................. <br /> ' ---- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I how* prepared this application and that the work will be done In accordance MAIM fan JoingLi t' <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home Owner or Rtes <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 ome sub)eet ep Workman's Compensation laws of California.,' <br /> Signed ��Sj <br /> ................ Owner <br /> BYr .....___.. ................................ .. . ........... Jitle ..................... ~�:":..... <br /> It other than owner) __._........ <br /> .._. _._..;.. <br /> FOR P TMENT USE ONLY . <br /> APPLICATION ACCEPTED BY..... ' <br /> BUILDING PERMIT ISSUED ............... DATE ••... <br /> ......_...._..._... .... . -- ....._.....-..e............_.....................DATE ......._..............__...... <br /> ADDITIONAL COMMENTS ....... <br /> ............._. � ....._.._.. <br /> •-----................•-----..__..._...-....._.._........--- <br /> ............... <br /> _. .................- <br /> ................ .... ... . _ .-...---.-...------ ........---._... -------... . .............. <br /> Nftfinal Inspection <br /> ..............:..._ <br /> t <br /> Ell 13 2L 2-611 Rev. --- <br /> .--•-•-- -••---_-----------................._.... .. __..._ ..... � ... ...... <br /> .... ­­ <br /> SAN _. ....Dote .... . - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 9�7lr 3!`1 <br />