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ILK., <br /> FOR OFFICE USE- <br /> ...... ----------- ..... APPLICATION- FOP_ SANITATION PERMIT, <br />........ ........­­­...... (Complete in Triplicate) Permit No. . ....... .......... <br /> .................... ................... This Permit Expires I Year From Dom Issued Date Issued ..��_ d--7s- <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 /> JOB' ADDRESS/LOCATI?N <br /> ...:_.:CENSUS TRACT ......... <br /> Owner's Nome ....... <br /> ­-1X01_4_ _%1PW_V- •--------- ------------ --- .,.....Phone .................................... <br /> Address <br /> Contractor's Nome . ...................... ......... ...... <br /> ............ ...... <br /> - - -------- - -------1- City <br /> -License <br /> .. Phone <br /> Installation will serve: <br /> Residence 'Apartment House C] Commercial C]Trailer Court <br /> Motel C1 Other ...... <br /> No-mber of living units:..-.,/. Number of berooms _.. Garbage Grinder Lot Size <br /> . ............ <br /> Water Supply: Public System and name ...... <br /> ........ ......L.......... .......Private <br /> ❑ <br /> Character of soil to a depth of 3 feet.. SandC] Silt E] Cloy El Peat E] Sandy Loom E] C I lay Loam 0 <br /> Hardpan E] AdobertJ,* Fill Material <br /> AWN ...... If yes,type .......... ......... <br /> (plof 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 TANKSize-- ------- <br /> Liquid Depth ---- ------------------X_ <br /> CapocitV!;�047 6-41i(,Type/.A-cr_�Materiol Compartments <br /> Distance to nearest. Well ,,hO— I --------- --- Foundation .ZO!�. '0, 0 <br /> ......... Prop. Line \9 _ ---- <br /> LEACHING LINE No. of LinesLen <br /> . 62 rp Z <br /> gth of each line Total Length ............ <br /> 'D' Box --- Type Filter Material Aad.06...Depth Fifter'Material JA <br /> Distance to nearest. Well ----------- <br /> Foundation ...1 __.-...- line <br /> SEEPAGE PIT Depth ....... Diameter -m7q__" ' .... . Property <br /> ­­ Number ........ ...... Rock Filled Yes No <br /> Water Table Depth ... . <br /> - . <br /> ... ----Rock ...C.. <br /> Distance to nearest. Well <br /> ---------._________..FounclationProp. Line --- <br /> ................... <br /> REPAIR ADDITION(Prev. Sanitation Permit# --------------- - ---- --------------------- Data <br /> Tank (Specify Requirements) ..... ---- ------ --------- <br /> ------_------------ .......... ............ ------------- ---------- <br /> Disposal Field (Specify Requirements) -----_------------------------ <br /> .................. - <br /> ------------- --------- ..................... ........... ......... ......... ......... ....... <br /> .......... ............. .... ..... <br /> (Drdw 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 San Joaquin Local Health District. Nom! owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I <br /> as to become subject to Workman's Compensation laws of California.— shall net employ any person in such manner <br /> Signed .... <br /> *- Owner <br /> --- --- ------------------ ......... <br /> By ---- -- ;��' <br /> . ....... Title <br /> Z <br /> (if other than owner} ..... ... ....... <br /> OR <br /> ­.....- FDEP TMENT E ONLY <br /> APPLICATION ACCEPTED'BY . <br /> BUILDING PERMIT ISSUED ..... ... ... <br /> ATE <br /> -------- .............. . .......DATE <br /> ADDITIONAL COMMENTS --r------ <br /> -------- --------- ............................_..........11........ -------- <br /> .................... ------- <br /> ......­......... ......................... ....I.... --- ------------------- ............. ..... ....... ------------- - ----------------*-_.-._1 <br /> ............­.......... ......-_1-------- ------ ........­­___.... ..........­­--- ----------­__­ .......­­--------------- --- .. . ..... <br /> Final Inspection by: ------------ ------ ---------:W-----------­...... <br /> ......... ------Date ..... . <br /> ----------- -------------- a. .................... <br /> SAN, JOAQ1 IN,/LOCAL HEALTH DISTRICT, <br /> E. H. 13 24 1.'68 Rev. SM <br />