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FOR OFFICE USE: <br /> ---------------------------------- .............. APPLICATION FOR SANITATION PERMIT <br /> ------------ .......•......... lCompleto in TrIplicatel Permit No. .727A�Z- <br /> ................... .......4....... .................... This Permit Expires I Year From Date issued Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District fora permit to constrt;ct and install the work herein <br /> described. This application is made incompliance with County Ordinance No'. 549 and existing Ruler, and Regulations- i <br /> JOB ADDRESS/LOCATION <br /> Owner's Name ...... 1�..CENSUS TRACT .......................... <br /> ..................... .........................Phone .............. ......... <br /> Address <br /> ............ <br /> .......1 C4,........S--—/ 0.P-. <br /> Contractor's Name ..P- ........ ...... Phone <br /> 710 <br /> Installation will serve; Residence Apartment House 0 Commercial r <br /> -]Trailer Court 0 <br /> Motel El Other ....... ............. <br /> ..................... <br /> Number of'fiving-4nitsi-1- -6 <br /> .. ... Number of b6dr-ooms- <br /> Water Supply.. Public System and name ......... <br /> Character of soil to a depth of 3 .......... ....... ................."-......................Private <br /> feet: Sand E] Silt 0--- Clay 0 Peat 0 Sandy Loom 0 Clay Loam 0 <br /> Hardpan 0 Adobe;R FIRM6terlal ............ if yes,type............... ............ <br /> EN <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 feetj <br /> PACKAGE TREATMENT SEPTIC TANKP4 Size--V.-X...r. <br /> T....... .......... Liquid Depth .... ........ <br /> Capacity X�P-;?--C-ftType ARC-• r Material Nop <br /> Com ortments ....... <br /> Distance to nearest: Well ------ 1 .............. <br /> --------------------Foundation <br /> f ._._..J40-1...... Prop. Line .... ......... <br /> LEACHING <br /> -INE No. of Lines ------Z--7:----------- Length of each line-.-----16 ......I Total Length ....../.74 <br /> 'D' Box .__.f----- Type Filter Material 1`4 ........ <br /> . Z .........-Depth Filter Material ...... <br /> Distance to nearest: Well --- 13 -A <br /> ... Foundation ___... ^.J....... Property Line ........5...... <br /> SEEPAGE PIT X)—Di-pth- 4gj7�!. Di0.3 4 <br /> ameter ..... ........... Number ...... 96ck Filled-"'Yes' jell eNo 0 <br /> Water Table Deipth%:-',--------- ---------------------Rock Size .... 2--1-1 -#.1 11-? .,. .". <br /> 1�............. <br /> Distance to nearest: Well ....... <br /> -------- ----------Foundation <br /> ...... . P . Line .......REPAIRADDITIONJPrev. Sanitation Permit# ....------------ .... .......... Dote— <br /> cs. I..... <br /> rop <br /> Septic Tank (Specify Requirements} ...... <br /> ------------------- ............................................... ..................... ....................... <br /> Disposal Field (Sp'jecify Requirementsi --------- <br /> .......................... -------------- ............................. ------ <br /> ---------------------------------- ---------I ------------------- ------------ <br /> ------------r...... ...... ............. ........................ ........... <br /> ------------- --------- ----------------- ---------------- -------•-•-------- <br /> addition on­r�v`er-ie-44�j.................. -----------I......... ...... <br /> (Draw existing an required _............ <br /> I hereby certify that I have Prepared-this application and that the work will be done in accordance with San Jdaquln e <br /> County Ordinances, State Laws, and Rules'and'ltegivldtiions of the Son Joaquin Local Health:District. Home. <br /> sed agents signature certifies the following- I N -owner or,11ceft. <br /> "I certify that.in-the-performance.of..1he workfor-whlch#thls permit is Issued, I shall not employ any person in such manner <br /> as to becomesubjeto-workm7n's ComPentation laws o1alifornia." <br /> lSt <br /> Signed - <br /> z-�............ <br /> ......... <br /> Owner <br /> By .... .. <br /> ---- ------ ........... <br /> ........ -- ---- Title ........... . <br /> (If other than owner) . <br /> MC <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> --- ---- -------------- - ------4------- ------------ <br /> BUILDING PERMIT ISSUED -- .7 .DATE <br /> ---- .........r------------ <br /> ------------------------ ------- <br /> ADDITIONAL COMMENTS ---------------------------DATE . ......................................... <br /> ----------------- ------ 1--------------- .......... ----------- ------------- .......................... --------- ------------------- ......................... <br /> ----------------------------------- <br /> -------------------- ---------------- .................... .............. .... ............................... <br /> -----------------------------.......... ----------------------- ------------------------- ------------------------------- ----------- <br /> , --------------------- .........I-------- ---------------------- ................I.......... --------- -------------- <br /> Final Inspection by: ------- <br /> EH13 2h 1-68 5H SAN JO------••-------------••-•---------•_...-----...... ............. <br /> SAN JO LOCAL HEALTH DISTRICT 8/7h 3M <br />