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FOR OFFICE USE: <br /> ZZ, ITATI ERMIT 70 APPLICATION FOR SAN ON P 4�,t <br /> - --- <br /> Pe <br /> rr&L.' ------I—....... <br /> lCompleta in Triplicate) <br /> —----------- This permit Expires I Year From Date Issued Date Issued _012------ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to 'construct and install the work herein <br /> described. This application is made in compliance with County Or5linance No. 549 and ex' ting Rules and Regulations. <br /> JOB ADDRESS/LOCATION .------ -- <br /> - <br /> ---- -------- ... <br /> -----CENSUS TRACT _76--------------- <br /> Ownef's.Nome,,,_,; Cf <br /> - & <br /> - - -----.. -------------R o ------- <br /> Address - <br /> Contractor ---_--_--------------------------- <br /> - <br /> ------ -.--License#-_Rt5_311Z-3--- Phone <br /> Installati6n will serve- sl Ce❑Apartment House f] CommercialOr rt oiler Court <br /> IMotel. El Other------------------------------------------------ <br /> Number of living units_____________ Number,of,bedrooms..------------Gorbc!ge ..Grinder ------------ Lot Size <br /> ------------------ <br /> Water Supply. Public System and name - ------------------------------------------ -------------------------------------- Private>� <br /> Character of soil to a depth of 3 feet, Sand r].A Silt 0 V `Gay, [] <br /> iin <br /> Peat <br /> Sandy Loam ] Clay LoamE <br /> Hardpan AddbeFill atetial------------- <br /> If yes,type---------1-1-------------- <br /> X <br /> (Plot plan, showing siie of lot, location�.of,systern,in.relation jo­�wel I' buildings, etc. must be placed on reverse side.) <br /> Nt <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> P ' 6 ' -.'k I <br /> ACKAGE"TREATMENT SEPTIC TANK[ Size------------------------------------------------ Liquid Depth ------------------- ------ 1� <br /> jV4,t Capacity -------------------- Type -------------------- Material------------__ _------ No. Compartments ------------_--_-- <br /> F Distance <br /> ----------- <br /> Distance to nearest: Well ------------------------------------Foundation ------------------ ----Prop. Line ---------------------- <br /> LEACHING LINE. f No. of Lines ------------------------ Length of each line---------------_______------ Total Length --_________-__.__.---------- <br /> F <br /> ----------­­1---------- <br /> V Box ------------ Type Filter Material ____________________Depth Filter Material ----------__--------------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line- __________-_____-.--____ <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ <br /> Na 0 <br /> Water Table Depth ------------------------------------------------Rack Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -_-------------------------------_) <br /> Septic Tank (Specify Requirementsl ------------- ---- --------------------------------------------- <br /> Disposal Field (Specify Requirements) Zoe ---------15- <br /> ------------------------- ----- ------- <br /> -- --------- ------------------------------------- ------ ------------—----------------------- <br /> - - -- --- -------- ---- -------- <br /> - -- -------------------------------------- <br /> 4rj",�ddition Xonreverse side) <br /> (Draw existi eand eq4uire -_ __V_ <br /> I hereby certify that I have prepared this application and that the work will he done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the perform e 4 work for which this permit is issued, I shall not employ any person in such manner <br /> k*e su pe ; mpensroitl, <br /> as to b 'a 4 an�s i-114ws of California." <br /> Sig <br /> ned su --- --- - Owner <br /> 7_ 7--- - -------- <br /> By ---------------------------------------------------- <br /> ------------------ -- ------ ----- --------------- ------------ --------------------------------------- <br /> (if other than owner)M ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------- - ------ ---- ----------------------------_--- DATE ---- /7�7 ------- --------- <br /> BUILDING PERMIT ISSUED --------- ---- ----- -----------------------------------------DATE ----_---------------------------....... <br /> ADDITIONAL COMMENTS <br /> ------ ---- -- ------ ­­.- <br /> -----------I-,--,'------------------------------------I—'--------------------------------------------------- <br /> .............. <br /> --------------—71-------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------- ......P(..2�_�----- ----- -------------------------------------------------------------- --_----------------- ----------------------------- <br /> ------------------------- <br /> -----­­­-------------- <br /> -------­----------_---j�------------------- ... .. ........ -------- .................. --------------------- -------------­----1------------------0�---------- <br /> Final Inspection by: ----------- <br /> - --------- ---------------------------------------------------------Date - ------6... <br /> N J QUIN LOCAL HEALTH DISTRICT <br /> E. H.'9 1-'66 Rev. 5P <br /> �j <br />