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FOR OFFICE USE: <br /> APPLICATION SANITATION ^ <br /> �� / <br /> (Complete in Tdp|/����) Permit No.���������� � ! <br /> This.Permit Expires 1 Year From Date Issued Dote |sooe6 .y�����k��� � <br /> ^ � <br /> Application is hereby made muthe Son Joaquin Local Health District for o ' i+ to »construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and ax|m\nQ Rules and Regulations: `. ! <br /> � . <br /> JOB ADDRESS/LOCATION - -� C7�- /�'- ----- _ ---------CENSUS TRACT ......--'----- ' <br /> Ovvner'x Nome ----ll�x�]��-_ ���\�/�z4���-_--.-----.---------.-'------.Phone-------.--.--' � <br /> ' * <br /> �J6 /�-. <br /> e,, --..�*�x�'��-._._-z�.7�JC��..��.{�_ ..-----�--__'_ Chy ���7-�� ----------------------------------------------- <br /> Co <br /> ._---_—_----Co n troc to,'x Nome ` License # /����� Phnna � _^ / <br /> ----'���-----------'~'~-�---'----� '^^ �^/'°~- ^r'7, �^*c—�-_ � <br /> |nmq|kation will xon/e Residence 2-Apartment ul ~~-E] Commercial T--- <br /> �r~`|kyCourt :7 ' <br /> � <br /> Motel E] Other ----- ---_-----' U <br /> Number of living units:' *J Number of bedrooms ,7 ^'`.Go,6ogo Grinder `-.' Lot Size ---------------- <br /> Water Supply: <br /> .—.--VVoterSupp/y. Public System and name - ---------------- <br /> --------------------------------------------Private M <br /> Character ofsoil modepth of3feet. ^ Sand#' Silt El Clay t-]' Peat Sandy Loamf'-,!E] Clay,Loam ' <br /> HondponEj Adobe �FiUMcitodoL------------ |{yes, type^--------------------------- <br /> (Plot plan, y6uvving size of lot, location of system in relation to wells, buildings, e�. mvx+ �m placed �n reverse side.) <br /> ' <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public snvvar is ovoi|o6(e within 200 feat) &w ! <br /> ~ � <br /> PACKAGE TREATMENT [ I SEPTIC TANK Siza-.---.-----------.- Liquid Depth -------------------------- <br /> Capacity --------- <br /> ----.-_-'Copocty --- --- ------ Type -------- MotariaL------, No Compartments -_.----.-' � <br /> Distonce to nearest: VVuU ---'_-.___Fovn6o�on ----'_. Prup Line --------- <br /> �� � <br /> LEACHING LINE [ ] No. of Lines ----_--'- Length of each line----------------------------- Total Length ------_--------------- <br /> 'D' <br /> ---_'-.—'D' Box --- ------ Type Filter Material ------------------- Filter hAmter|o| -------------------- -------- -------------- <br /> Distance to neon,m` Ve// . �� Fuun6mhon ����--~----'' ' <br /> p'»Pe'h/ Line ----------------- '-- <br /> 3EEPAGEPIT [ j Depth -- ----------------- Diameter ---------------- Number --------- ---------------- Rock FU/ed Yes F-1 No <br /> 7 / <br /> Water Table Depth ------------------------------------------------Rock Sba '--.�_.!—_�— <br /> . . <br /> Distance tone.on*c» Well -----.----------Fnundohon ----------- Prop. Line .-.---.-.'. � <br /> (Prev Son�o/�n Pe�m��� -'---� ��-------�-. Date -------_----} � <br /> ---- ~-- � <br /> Septic Tank �pecifyRequirements) / <br /> Disposal Field (Specify Requirements) <br /> --------------------------------------------------------------------------------------- <br /> (Draw existing and requited addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be don� in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature'Certifies the following: A <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 /> ;7 1 , workm s ompen <br /> Signed ------::,� <br /> my ------------ ------------------- --------------------- ----------... 7|Ho ----- -----� <br /> (|f other than owner) ----��---''�r--'--- � <br /> FOR DEPARTMENT USE ONLY <br /> ' <br /> APPLICATION ACCEPTED �' <br /> ---------- <br /> BUILDING PERMIT ISSUED 7_� <br /> ' ' ^, - ------'����------- -'^^ '° -^~----��_ ________,~ _____ . - DATE <br /> ------------- <br /> ADDITIONAL [{}&\�\ENTS --� ���� --' ---- ---�--------- ' <br /> ---'--'---'—'�--'x&/���-�__-��v?�--_.����Y�z�.���-.�-. ^'. _.____- -�_ ___� | <br /> ���������������'�'���_����'�������-------------'�'��-------------'�� -------------------------- / <br /> -----_---/�'—.'�� <br /> Hno| |nopac�on6y -y�«�.x�-' —'� --- <br /> -------''''_�—�-.Do�e- <br /> / � <br /> 8AN JOAQU|N LOCAL HEALTH DISTRICT <br /> E. H. 9 1''68 Rev. 5M, <br /> ` ' ' J <br /> ^^ ~ <br />