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do <br /> FOR OFFICE USE: FOR SANITATION PERMIT <br /> ------------------------ --------------­............. Permit No. W:n _7/ <br /> /4? <br /> (Complete in Triplicate) <br /> ................................ ....................... <br /> ---_________________________•.._..._..•....______ Th Is,Permit 6xpires I Year From Date Issued Date Issued 0-- TO-TO <br /> Application is hereby modetci,ffie San Joaquin Local Health District for a permit <br /> mit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. <br /> JOB ADDRESS/LOCATION .-JI&4g-------ir WF7......*ql?-DIV. ------------------------------------CENSUS TRACT ...... ............. <br /> V <br /> Own'er's Nome •-----{Me ;;Oz I qx.-s-------------- ..................... <br /> .......... .......... ....................Phone_47 _-------------- <br /> .1.1 <br /> e8Add;ess ---- -Ilel-Af.,_ - city --- ----,-- --p-V-y- <br /> --- --- - ­ .......... <br /> Contractor's <br /> Name .... ....... ----------- Phone <br /> ........ ............................. icen e ... ---------- .......... <br /> rN <br /> I <br /> Installation will serve: '"Residence [N Apartment House 0 C;mmer6i [0Tr.9iI6r Court tj <br /> Motel D Other...... ------- <br /> -------------- <br /> _7 <br /> Number of living units------ ..... Number of bedrooms ---�.__.Garbqge Grinder --- Lot Size ------ ......... ............. <br /> Water Supply: Public System and Sandy Loom 6 Cloy <br /> Clay 0 Peat Sand Silt name --------------------—.......... ...... •----..._.._.....----- <br /> r oil to a depth of 3 feet: - <br /> 1i Loam 0 <br /> Character of soil E] <br /> Hardpan O Adobe 0 Fill Material,_A/0..t Ifyes,_tV:peL...........t� <br /> lPlot.-plan, showing size of lot, location of system in relation to wells, 66ildings, etc. musti be placed on reverse- side.) <br /> 14EW INSTALLATION: (No sopticjank or seepa'ge pit permitted If pul3lie seW4�rs available within 206 feet,) <br /> PACKAGE TREAX,MENT f I SEPTIC TANK T I "Size................................................ Liquid Depth --------------- <br /> Capacity .................. Type -------------------- Material--------------------._ No. iCompartments <br /> Distance . --to nearest: Well ....................................Foundation ....... ----- - --.- Prop. Libe ...................... <br /> To� <br /> LEACHING LINE No. of,Lines ---- - ------- ------- Length of each line-- o-I <br /> ------------------------- Length J...............J........ <br /> 'D' Box J--------- Type Filter Material _•------------------Depth Filter Materibi .---------_----- ---------------i---------- <br /> Distance to nearest.. W611 ........................!fouhdotion- -------------------- Pr6perty Line ........ .......... <br /> SEEPAGE PIT Depth __J-------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes b -' !No 0 <br /> Water Table Depth -------------------- ---------....---Rock Size --------------------- ...... <br /> Distance to nearest. Well .................................:......Foundation ........... -------- Prop. Line ...........I.......... <br /> REPAIRJADDITICISI(Prev. Sanitation Permit S# --------------------------------•------•.--- Date .................................. <br /> .. ......... <br /> .. .. <br /> Septic TankISpecify Requirements <br /> D posa <br /> IS I Field (Specify Requiremenis) -------- IN E:VV <br /> AuTUi Z X _C_ IV <br /> -6- ------------at-5-flK-4 .....S frti _TA - K .... ...... <br /> -------------------------------------------------- •-•-•-•--•-------...._.....-------- .............. <br /> =+(braw-existing and required-addition on reverse side} <br /> I hereby certify that I have prepa,red this application-- that- the at.-the-work-will- e- one-, ance w <br /> bdin-accordith tai Joaquin <br /> s a <br /> County Ordinances, State Laws, and Rules aind Regulations of the Son Joaquin Local Health District. home ' <br /> owner or licen- <br /> sed agents signature certifies the following- <br /> A <br /> "I certify that in the performance of the work or which this permit is Issued, I,sh6II not ample any person, in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed 145, A Th r� �,Y- 5 n m I ----------- Owner <br /> ------------------ <br /> ie,0_ 0_6.n e/, <br /> By ----------------------------------- ............................... - ---------- <br /> -th <br /> If oil['& aa�6�_ntol. <br /> '9EPA <br /> FOR -RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Rx)---_-------- -----------•--------•-•---------------- -------- •--•----•--. DAfE ----42 <br /> BUILDING PERMIT ISSUED ..........I------•................••----- ---------------------------------------------------------------DATE .-.,------------ .............. ........... <br /> ADDITIONAL COMMENTS ------- <br /> -------------------------------------------------------- ----------------------------------------------- ......... <br /> ---------------I-------- --------------- ---- - <br /> ----- -------- ------ . . I ; . i <br /> ------ ----------- ........................... -----------_-------- ------ -- <br /> --------------- .................... ----- -------- --- <br /> ------- ---------- ----------------I--------------------- ----------­-­---- ------ <br /> f <br /> --- -------- ------------- --- - -- -- ----- - --- - ----------I-------------------- ----------------------------- <br /> FinalI ..... ---- ---- -------------_---T7-- ---- ......Date ------- ---- <br /> SAN JOAQL!IN LOCAL HEALTH DISTRICT <br /> E. H. 9 , 1268 Rev. 5M. <br />