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Kim OFFICE USE: <br /> ...................-.............I............... APPLICATION FOR, SANITATION PERMIT <br /> ...... ......................... lComplete In YrIplicate) Permit No. ZY:7:/�d.L <br /> ........ ..... tz, <br /> .......... ............... <br /> This Permit Expires I Year From Date Issued Date Issued........... ......... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to constru <br /> described. This application is made in compliance with County Ordinance N ' ct and Install the work herein <br /> o. 549 and existing Rules and Regulations- <br /> L60 s-z <br /> JOB ADDRESS/LOI g <br /> z.4S <br /> ......TRACT ...........��_ <br /> Owner's Name ...................... .......Plibne ........ ....... ....... ........... <br /> City ....................... <br /> Address ...... ........... <br /> Contractor's Name "I <br /> ------�.,Q..__.••- ...... ......... 14.......... .-•---.License Phone`��4�_17_ <br /> Installation will serve- Residence9<P`a_r1ment House 0 Commercial <br /> QTtailor Court 0 <br /> Motel 0 Other......... <br /> .................................. <br /> Number of living units:-..-,, <br /> Number of bedrooms ...:?___-Garbage Grincle C.-i... Lot Size ... <br /> Water Supply: Public System and name <br /> I, -----------------................... ...............................Private 0 <br /> Character of soil to a depth of 3 feet. Sand El Silt 0 <br /> Cloy 0 Peat 0 Sandy Loom 0 Clay Loom 0 <br /> Hardpan Ej Adobe `Fil I M6terlal ,4.1!'. If yes, fypp..... ........ ............. <br /> (Plot Plan, showing size of lot, location of system in relation to'wells, buildings, etc, 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 SEPTIC TANK e........../ ..... -Liquid Depth <br /> .......... <br /> terlol <br /> No. mpartments ....... <br /> Capacity Type M. <br /> , istance. to nearest: Well <br /> w�_ .........Foundation .............. Prop. Line ....4�5 <br /> LEACHING LINE r No. of Lines of epch -line:..'- %.:-Total & <br /> ........ Length X7 ... <br /> V Box tej- - Type Filter Material [;44�� ..Depth Filter Material ........IX..-�e-....... ..... <br /> Y_ - ... ....... <br /> ce'to nearest: V •----- Foun'd6hon ........... Prope ' Line . <br /> ' ' .6��............. <br /> Distan Well Property <br /> SEEPAGE PIT le/"�Depth Diameter .3....... Number ------- Rock Filled Yes g-19a C) <br /> jo / <br /> Water Table Depth .........-9 ............. ...............Rock Size <br /> Distance to nearest: Well A <br /> Prop. Lin ........ <br /> ............Foundation <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............ .............. ................ Date ............. <br /> Septic Tank ISpecify Requirementsl ...... ........... <br /> ................................ ........ ............. ........... .......... ................... ........ <br /> Disposal Field {Specify RequiremeW_91 ------- <br /> hl ------ .......... ....................................................*-----------*---------------- ............... ........... <br /> ------------- -------------------------- <br /> ...... ...... --------------------- ------------- ------------ ---------- -------- ................................ .......... ................. <br /> ------------------- --------------------- -------------------------------•-------- <br /> --------------------------- ------------------ ....................................... ....................7....... .......i, <br /> --- <br /> •-------- <br /> -- k <br /> (Draw • <br /> existi6g.ancl required addition on reverse sidej <br /> ! hereby certify that ! have prepared this application--and that <br /> the work will be done in:accordance with San 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: <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 becormn subject to Workman's Compensation laws of California." <br /> Signed .... --- ---- --- --- -- ------ -- ----------------- ---- -------------- Owner <br /> By ----------- .. . .... -------- .....r <br /> 0 ------- ... . ... ................. ............ Title <br /> her than owner) ------ ---------------- <br /> FO ENT USE ONLY <br /> APPLICATION <br /> .-ACCEPTED 8 ------ ---- - ---- ... ....... <br /> MIT --------------- DATE <br /> BUILDING PERMIT ISSUED --------- ...... ------ 11 <br /> - <br /> nt,t A ---------- ........... .......... 'DATE ........ --------- <br /> ADDITIONAL COMMENTS .---- ------------ --- ......I-- - ..-- ---------- ------------------------------------ <br /> ...................................._­......... --------- --- <br /> . . . . . . ....................... *........................................... <br /> ------------- ------------------------....------..............--.._•,- <br /> -------------- .................-1--------- <br /> -- ---------------------- <br /> ------------ ------------------------------------------------ ------*------- <br /> ----------------- - -------------- -------------- ----- ------------- ........... <br /> ------------------ ...... .... ......... <br /> ....................... ............ <br /> Final Inspection by: ------------ ----------- --------- <br /> ------ ....... . - - ---- .....11------ -------••- --- <br /> Cm <br /> EH 13 2h 1-68 Rev. 5M .-......-..-...-Date .... ....... ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />