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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERM <br /> .. ...........I�..?" I 7(-f72- <br /> ........ ................... <br /> (C"Plete b%Triplicate) Permit No. ......-.__._.._...--_ <br /> ......................................................... <br /> Date ssued .1P.--11.74 <br /> ............—.—.................................. This Permit Expires I Year From Dot*Issued <br /> Application is hereby made to the Son Joaquin Local Health 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 /> 11 <br /> JOB ADDRESS/LOCATION ....................iCFNSUS TRACT .................... <br /> 3Z-3-5 <br /> Owner's Name ---------- <br /> ................... ........................ ......Phone Wi <br /> ----------- . .1I ..................... ------- <br /> Addresssiel.^01 ................ ... ................ ....... ............ City ......1-........ ...................... <br /> Contractor's Nome ------------ ....... .........................................License# ........ .............. Phone:...................... ....... <br /> Installation will serve: R sidence)q Apartment Housef] Commercial OT-railer Court 0 <br /> Motel n Other...............--.................. ...... <br /> Number of living uniti-.--..---L Number of bedrooms ....Garbage Grinder ............ Lot Size s��............. <br /> Water Supply. Public System and name .----------------------- ............................................ ........ ..........Private <br /> Character of soil to a depth of 3 feet: Sand I-] Silt 0 Clay [] Peat E] Sandy Loom §r Clay Loam 0 <br /> Hardpan 0 Adobe'o Fill M6terial ............ If yes,type ............ .......... <br /> (Plot plan, showing size of lot,-location of system In relation to wells, buildings, etc. must be pWed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT f ] SEPTIC TAN --------------------- Liquid Depth ....... _.:,>........... <br /> Capacity -./W i .z <br /> Typefro--!;,�1-51-Materlol..... Compartments ............. <br /> Distance to nearest: Well ........... ...............Foundation Prop.'Line <br /> LEACHING LINE, No. of Lines ......... Length of each line........ka............ Total Length ._.._...f.4-0------...... <br /> 'D' Box .....�&... Type'.Filter Material Depth Filter Material .-AA...il.................. .......-.- <br /> Distance to nearest.. Well ...... foundation ... Property Line ......0.q.-4.....- <br /> Depth3.'y* -/012 ' <br /> - ------X--------- lWarfwwr ................ Number .............2------------ Rock Filled. Yes S No 0 <br /> 5 Water Table Depth --S <br /> 3 U .... -------7 ---------------------Rock Size .2::..___..--.........._..-.p. <br /> Distance to nearest. Well --- ................Foundation -------1407L. ProLine ....If 49- -It........ <br /> R EPAIR/ADDITION JPrev. Sanitation Permit# ............................................ Date .................................. <br /> SepticTank {Specify Requirements) ......................................... .................... ........... ............ ............. ...........__............-•-- <br /> Disposal Field (Specify Requirements) ..... .................:•----•-•--••..._-.:--•---------------------------- ...III................... -------- <br /> ............... ------------------------------------------------------------------- .........-'-.....................--------------- ........................ ........ <br /> ----------------------------------------------------------------------------------------------------------•-•-•--.._.__...•••.•••-• ----•----._.._...--- I.............................. <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 accorclancewith Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health;District. Haire owner or liter- <br /> ! agents signature certifies the followingIf <br /> - <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 /> By --------------- ----------------- ------------------------------- --------------- ---------------- Title -.-------------------.........--------- -----------I................. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... 6 <br /> ---------------------------- .......................... DATE ./o// <br /> BUILDING PERMIT ISSUED -----------------;010 <br /> .......................------------------------------------------- -------.-DATE ........... --------- ---------- ------ <br /> ADDITIONAL COMMENTS ........... . .......... ......... --------- <br /> .................... ------------------------------- ........ --------------------------------- .........-.......--,-------------------------------------ii <br /> ---------------- <br /> ------------------------- - ----------------------------------- ....................... --------------- -------I------------1-.1--...... ----------------------- <br /> -------------------------------- .... ... ......... ----••-•-----•-•---•-----•------••--------.-K' ............................. ------------ <br /> Final Inspection <br /> --- -------..._...• ------- -------- ........ ---.----------........._Date ... <br /> EH "13 2h 1-68 It,.-v. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 18/7h 3M <br />