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FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT <br />Permit No. <br />-------- (Complete in Triplicate) <br />. ....... - --------- ------- Dote Issued -744` 61 <br />This Permit Expires I Year From Date Issued <br />------------- --- ------- <br />and install the work herein <br />Local Health District for a perm <br />it to construct ng Rules and Regulations: <br />Application is hereby made to the Son Joaquin <br />made in compliance with county Ordinance No. 5A9 and existi <br />described. This application is <br />TH ... CENSUS TRACT ......... <br />JOB ADDRESS/LOCATION _7 LO.... _4 <br />....... Phone ------------------------- ......... <br />- ----------- ....... ....... <br />Owner's Name>A_1D.4nF—_R,­ <br />MM------- ...................... <br />Address --------- -R-01 ..-.Boy..-- 12,93 ---------- ..... city ----- /, I <br />? - 'P ----- --------- <br />V, X ­­ ... License.# --- ......._ - lione <br />Contractor's Name ---- ---------- ------- <br />Installation will serve: Residence [] Apartment Hou'sef] Commercial ❑Trailer Geurt Kj` <br />Motel E] Other ---- -------- �_.Zl <br />Number of living units...__ f ----- iVumber of bedrooms -6arbage Grinder -- -------- Lot Size <br />\ I ' -------- Private (7 <br />------------ L ---- ---- <br />Cl oy Loom C3 <br />Water Supply: Public System and name - --------- - ------------------ -- I i..M_ — <br />Peat <br />y pe; E] Sandy oam ot", <br />Character of soil to a deptil.of 3 feet: t;.Sand 0 Silt Cla <br />------- -------- <br />Hardpan ❑ Adobe 7 Fill Mate'Hall ---- ..f.__. If yes, type ------ <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 />1.0 J( �7.. ........ _ Liquid Depth <br />PACKAGE TREATMENT SEPTIC TANK;fj�K" Size_.,�4X. I ­­ .- <br />Capacity' Type ON ' Compartments .... --------------- <br />C2 . _ . __ No. <br />Material <br />--Foundation ......... Prop. Line - ------ <br />Distance to nearest: Well -------- F6 Total Length ... . ....... <br />LEACHING LINE No. of 'Lines -9ow <br />-arses" Length of each OiM <br />lt� , ­­ ............ <br />'D, Box Type Filter Material Depth Filte; Material _7 <br />11, <br />Distance to nearest: Well ... Found'dtion ........ Property Line _....~-----•----• <br />SEEPAGE PIT Depth Diameter ---- ------- Number ------ ------------- <br />Rock Filled Yes C] No C] <br />Water Table Depth .. --_--------_--------- <br />.......... • Rock -Size,tv--t_ ------- -------------- <br />i I <br />Foundation, �_. --------------- _ Prop. Line -------------- <br />Distance to nearest: Well __­ --------- <br />I'i ------------ . ....... <br />REPAiP,/ADDITIONIPrev. Sanitation Permit# --_...•..----------------------- ---------- f•Date - ...---is <br />............... <br />........... ­__­­._­ ........ <br />Septic Tank (Specify Requirements) --------- ----------- z --------------- .......... ------- <br />' i i i --------- ........... --------- .......... ............. <br />Disposal Field (Specify Requirements) .....................••..•...----------------- -------- ............ � ­rL <br />------------ <br />---------- ------- ....... <br />----------- ::..-: .... ... --------- --- ­_; ------- <br />s. <br />...................--- <br />------------- ......... ------ -- ------- <br />......... --------- -------- ---- ------ ----- ----------- ----- ---------- - ------ <br />... .......... (Draw existing and required addition'IoA reverse syclel <br />I hereby certify that I have prepared this application and that the Work will be 0o"ne in accordance with Son Joaquin <br />County Ordinances, State Laws . , and Rules and Regulations of the San; Joaquin Loccil"Health District. Home owner or licen- <br />sed agents signature certifies th6 following - <br />permit is issued, I shall n1pt employ any person in such manner <br />"I certify that in the performance of the work for which this <br />I <br />as to beco e subject to orkmanI compensation laws of California." <br />Ow6er <br />S i 9 n e d \�L/ <br />------------------ Title._. .......... ........... ------- <br />By_--------- ---------- ----------- - ---- <br />(if other than owher) <br />FOR DEPARTMENT USE ONLY <br />V, DATE <br />APPLICATION ACCEPTED BY -------- ........... I --------- ----- ------­-----­-- J <br />------------ ...... ...................... ­DA7E ---•-•----------------••---•-----•-- ------ <br />BUILDING PERMIT ISSUED ---- ----------------------­-- ------------ ------ - <br />.... .... ................................................. -----_---------- ......... <br />ADDITIONAL COMMENTS. n /I <br />----- - --- -- ---------------------- <br />---------------- -----------­---­- ---------- <br />........... <br />----­-----_---- IN . ­­ -------­-------------­--- _1 ------- -- ............ -------- <br />------------ . ............. <br />-- ----------- I ......... ....... - ­ / -- ---- <br />................................ . . <br />------- ---------------­- - --- ----- Date- -- ---------- ­- <br />............. -----•--•....... <br />Finbl,ln*sp"e�tion <br />-_SAN. JOAQUIN LC)Ck��"_�EALT.H._bfSTRICT — <br />E. H. 9 1- . '68 Rev. 5M <br />