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2NU;FOP OFFICE USE: APOILICA7jot4 POR SANITATION PERMIT Permit No. <br /> (Complete in Triplicate) Date issued <br /> Issued <br /> ------------ ------------------7�--- ---------------- This Permit Expires 1 Year From Date <br /> • <br /> --------------- construct and Install the work herein <br /> -------------- )cal Health District for a Permit to ing Rules and Regulations-. <br /> 549 and exist <br /> made to the San Joaquin L(e with CoL-my <br /> Ordinance No. <br /> Application is hereby application is made-in comPlianc <br /> lic -CENSUS TRACT -------------- ----------- <br /> described. This OPP ----------------- <br /> JOB ADDRESS/LOCATION ---------- ----------------- -------------------phone ----01---- -------------------- <br /> 'I—- —------------- -------------------------- --------------- <br /> owner's Name ---------------- - ------------------------------�:­ City -------------- phone <br /> -------------- <br /> Address -------------------------- ��-------- ----------'License # ----------- <br /> - --- - ------ ---- <br /> Contractor's Name ------- --- Apartment House'[] Commercial Trailer Court ] <br /> Installation will serve- Residence)d ------ <br /> Motel []other ----------------------------- <br /> --------------------------- Lot Size -------- <br /> Number.r of bedrooms ... 5---Garba-ge Grinder -------------Private <br /> ❑ <br /> Number of living units:_---'_--_- -------------------------------------- Clay Loom 0 <br /> Water Supply: Public System and name 0 Sandy Loom 0 <br /> (e Sand Silt 0 Clay 0 1 Peat type ---------------------------- <br /> Character of soil to a depth of 3 feet: ------------ if yes, <br /> Hardpan ❑ Adobe Fill.Material <br /> reverse side.) <br /> t be placed on <br /> lot, 'location of system... in relation to wells,csewergs <br /> uildins, etc. mus <br /> (plot plan, showing size of .1 page pit permitted if publiavailable within 200 feet,] <br /> Depth -------------------- <br /> NEW INSTALLATION- lNo sept I-ic tank or see Size------------------------------------------------ Liquid rtments ----------------- <br /> p <br /> PACKAGE TREATMENT t ] SEPTICTANKI[ I I Material---------------------- No. COmP0 <br /> i -_ Type -------------------- prop. Line .------------=--°--.-- <br /> Capacity <br /> .. .....Capacity ------------------ <br /> ":-.f Foundation ------------ ---- <br /> - ----------- <br /> to nearest: Well -------------------------- Total Length ------- . •..... <br /> Distance Length Of each line---------------------------- <br /> LEACHING LINE [.4—No. of Lines ----------------- ...Depth Fffier-Material -------------------------- <br /> x ------------ Type Filter Material ----------------- ----- ----- Property Line --- -------------- <br /> r t'D' BO ell ------------------------ Foundation ------------- Na <br /> Distance to nearest: W -------- Rock Filled Yes <br /> VQ <br /> i Number -------------------- <br /> SEEPAGE PIT Depth'I-------------------- Diameter ---- -----------Rock Size -------------------------------- <br /> WateriTable Depth -------------------------------------------------Foundation -------------------- Prop.. Line ---------------------- <br /> Distante to nearest: Well ------------------------------ ------ <br /> ( _ il'I -- - ------ Date ------------------------------------------ <br /> REPAIR/ADDITIONPreV.-Sbrtation Permit -------- ------ ------------------ ---------------- ---------- <br /> ---------- <br /> ments) ----------------------------------- <br /> ---------------------------- -------------- <br /> septic Tank (Specify Require ----- ------ -- -- <br /> F I uirementsi --------- -------- ------------ ------------ ------------ <br /> Disposal Field (Specify Req -f ------- - <br /> ----------------------------------------- 4 ------------ <br /> ------------------------ ------- <br /> ---------------------------- <br /> ----------- 4�4v�------ - _X------- <br /> ------------------------------------------ <br /> ------I------------------------xis-t-i-ng and required addition on reverse side) with Son Joaquin <br /> I (Draw e work will be done in accordance ner or licen- <br /> ��reparecl this application and that the w <br /> that I have an Joaquin Local Health District. HOMO Ow <br /> I hereby certify m s and Regulations of the S <br /> county ordinances, State Laws, and Rule y person in such manner <br /> sed agents signature certifies''the f oil owing- this permit is issued, 1 shall not employ an <br /> n the performance Of the work for which <br /> "I certify that 1 nsation laws of California." <br /> as to become subject to Workman's Compe Owner <br /> � I.I --------------------- <br /> Signed ------------------------------------------ ------------ ------------------ Title -------- <br /> By -------------------- -- -- -- --------- ------------ <br /> (I other an er) DEPARTMENT USE ONLY FOR DEP�ARTMENT USE ONLY ��r�4 7� - <br /> 5� <br /> --------------- <br /> DATE <br /> Eel' DATE ------------- ----------------------------- <br /> APPLICATION ACCEPTED -- ---- -------------------------------- - ---------------------- <br /> RMIT ISSUED-------------------------------------------------------------------------- ---------------- <br /> BUILDING PE 41- -------- --- ---------------------------------------------------------------------------------------- <br /> ------ ------------------------ <br /> COMME--------------4 -------------------- ---------------------------------- --T" <br /> NTS.- ---- - ----- ---------------- ------------------ <br /> t ------------------- ------------------------------- <br /> ADDITIONAL----------------------------------- e�� --------------------------------- ------- ----5A-------- ----------- <br /> --------------------- J, A ----------------------- ---------------------------------------------- <br /> ------------------------------- ------------------------ --------------------------------------------- ----------------Date <br /> --------------------- -----------AA <br /> - ------------- ----------------------- <br /> Final Inspection by SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> C U 0 1-'68 Rev. 5M <br />