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m 41P <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> y <br /> .................................•---------.......... Xc t _ <br /> (Complete in Triplicate) k �- Permit No. 3 f- <br /> _7A <br /> Date Issued................... <br /> .................. <br /> ................ _0­­-------w.... This Permit Expires I Year From Dote Issued <br /> Application is hereby made to-fFe—So_n Joaquin Local Hdalth District for a permit to construct and install.the,work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB . ........................_._......CENSUS TRACT .......................... <br /> Ow' ner's Name .......�_,0.114/................... ...........................................Phone ..................................... <br /> C-4-44- ...R-E,1-!.-.----4.1,S1 City .......................... <br /> Address ............... ...... <br /> Contractor's Name ............................................License ..... Phone <br /> Installation will serve: Residence;Z Apartment House 0 Commercial OTrailer Court 0 <br /> Motel []Other:-------------------------------------------- <br /> Number <br /> ther ............................................Number of living units...:9------- Number of bedrooms ............Garbage Grinder/VD---. Lot Size ............. <br /> Water Supply: Public System and name .......... ............................................................................................Private <br /> Character of soil to a depth of 3.fbet: Sand E] . Silt E] Clay 0 Peat-[3-- Sandy Loam 0 Cloy Loam o-s- <br /> H ardpon DU Adobe-E] Fill M6terial ............ 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 /> PACKAGE TREATMENT ( ) SEPTIC TANK 11 Size........................__.................... Liquid Depth ........................... <br /> Capacity -------------------- Type -----------_----_ Material---------------------- No. Compartments I....... <br /> Distance to, nearest- Well ....................................Foundation ...................... Prop. Line :.......... <br /> LEACHING LINE No. of Lines ----------------_----- Length of each line-------.-------------------. Total Length ..................:_......-- <br /> D' <br /> .................I—......V Box Type-Filter Material ... ........Depth Filter Material ................ ...........................kA <br /> Distance to nearest:'Well ........................ Foundation ........................ Property Line ___ .............. <br /> SEEPAGE PIT O Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes [3 No Op <br /> Water Table Depth ..:....-...Rock Size �.......4....................... <br /> Distance to nearest: Well .............................Foundation ......_............ Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dote ............................. <br /> Septic Tank (Specify Requirements) --------............... . .. -------- 7..........---...-...--- <br /> .. <br /> -- - <br /> - .. .. <br /> Disposal Field (Specify Requirements) ..... <br /> I_ <br /> --- ......... L <br /> - -------------------------:------------I........... ................... ......... ---------­---------- -----------------......... ........ <br /> ...................................... ----------------------_.._...I........--•-•---•-•--•-•• •-- <br /> ( <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared:this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licert. <br /> sod 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 become subject to Workman's Compensation laws of California." <br /> Signed ........................ ....... Owner <br /> &_&................ title ........tAm���.......................... ............ <br /> By ..... ........................... <br /> (if other than owner) <br /> 42 m FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .....4f7' 611, ............v..................................... ....... DATE ....... 7.4 <br /> BUILDINGPERMIT ISSUED .................. ..............................................................I..............DATE ........................................... <br /> ADDITIONALCOMMENTS ........a................................... ....... .........................................................................................._............. <br /> ..........­.........................;­...... ........ .................... .................I-------------- -------- --------------------­-­ ..................­­........... <br /> ........_..1............. ........................ .......... .............................. ................................................................. ...........w­....... <br /> ............ <br /> ..... . . . ...................... ..........­­.........I..............­1­--- --- <br /> Final Inspection by: <br /> ...... . .Date ............... <br /> 'SAN JOAQUIN -LOCAL HEALTH DISTRICT <br />