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FOR OFFICE L,'sE: <br /> G APPLICATION FOR SANITATIW RMIT <br /> v Permit No. ., - - <br /> > (Complete in Triplicate) <br /> This Permit Expires 1 Year Frew"Date issued Date issued <br /> Application is hereby mode to the Son Joaquin Local Health District for a permit to construct arid install the work herein <br /> described.This application is mode in cornplionce with County dinance No_ 549 and existing Rules and Regulations: <br /> =. !OS ADDRESS/LOCATION iC.:`,a..�-.. iytitZ��- ...RV .. �( .�'1� �c�.)... CEMUS TRACE _._���........_....' ': ;" <br /> a <br /> Owner's Nome . ...........uww�- k ..� ........... .......... ...........................Phone�-�.10T......._..___... : <br /> i _ <br /> Address . -------City <br /> � <br /> . �C <br /> _...... <br /> F Contractor's Name SI-or _............. ..License# .... . . ..........-- Phone ................. <br /> ___..... <br /> installation will serve: Residence❑Apartment House C Commercial CTr_.ler Court ❑ <br /> w <br /> Motel 'Other �h J\__ <br /> .. ........ <br /> Number of living units: . -. .... . Number of bedrooms Garbage Grinder Lat Size parG�.................._..... <br /> WiterSupply: Public System and name ..... ._... ................ _.. _ ..................................................Private <br /> Cheracter of soil to a depth of 3 feet: Sand L Silt❑ Clay © Peat(] Sandy loom❑ Clay loom Q <br /> Hardpan Adobt• Fill Material .. . ....._.If "h <br /> pa {.7 � Yes.type....................... .... .:� <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ere. must be placed on reverse side.) <br /> NEW INSTALLATION.- !No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( j SEPTIC TANK( 1 Sire................... . ..-- .........-. Liquid Depth ........�. .._..... <br /> Capacity T Material..- No. Compartments <br /> Yip .. <br /> �r- <br /> Distance to nearest: Well .................Foundation. ... .._..........._.flop.line.......... <br /> LEACHING LiNE ( j No. of Lines - -- -------- ----- Length of each line - --............_........ Total Length ........._..__... <br /> N_. <br /> x 'D' Sox ... Typo Filter Material ........ _.._.__Depth Filter Material ............. .._...._._ - . <br /> Distance to neorest: Well . --.._..._ — - Foundation ............. Property Line <br /> SEEPAGE PIT O Depth .. . ............. Diameter <br /> ------ Numbs- - ... ................... Rock Filled Yes [3 No (� � <br /> Water Table Depth Rock S:ze <br /> Distance to nearest:Well -•--._..... Foundation .................... Prop. Line <br /> V"Alf b!)MON f Prev. Sanitation Permit# Date <br /> Tank(Specify Requirements) ...................................... .......... _............. _...... _......_...... ...._ <br /> y Disposal field (Specify Requiretnentsl SX 1�Xu...,SV.M f -- —L}, <br /> s _......_...._...._..................... ........................................ .._ ........_........................_......_..... ............._ <br /> ..-......... ._............................... _ . . _ <br /> ' (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have pr+epored this application and that the woric will be dens in accetodana with San Jeeptifa <br /> C~rdy Oedinvntxs, Slat Lavin, end Rvles and Reytrhstions of tho son Joaquin Local Health DisMd.Memo owner or lion• <br /> sod agents signator tortif#os tho foliowinyc <br /> "I eeNi Owt In P employ�person In such mattsser <br /> h perfet+nenq al tho work ler which.-isle ennit is issued, ( shell not etas I <br /> as to become subCompensation laws of California.,* <br /> Signed. _Owner <br /> ' Jitle <br /> Elf other than owned <br /> R FOR DEPARTi41EAIT USE ONLY <br /> APPLICATION ACCEPTED SY ? .-..-. ------­----- .--------........ .......... DATE..........' ... .L1... ....__ <br /> WILDING PERMi: ISSUED, re ... ......... - ' <br /> ADUITIC*NAL COMMENTS _ _ .. '._. <br /> _.......__ ---------- <br /> ------------- <br /> --W -----...-........ .......-.._....... _.......... ........_._......._.. <br /> -------- --. --------- --------......... ..... ......... �... <br /> ��es .,I'l .........._.._ . <br /> � Frnoi inspection bY� ---• ._. ... . <br /> Date ... <br /> G SAN JOAQUIN LOCAL HEALTH DISTRICT v <br /> E.H_9 1.'68 Rev.SM C `, <br />