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FOR OFFICE USE. P <br /> APPLICATION :FOR SANITATION PERMIT <br /> ............................ ................... 4�e�­ � <br /> er No_7o <br /> (complete In.TrIplicate) ................. <br /> ..........I-------- ........1.111.............. <br /> -------- ...... <br /> ..... ........ .. . ....... This Permit Expires I Your From Out*Issued Date issued .. G <br /> Application Is hereby made to the Son Joaquin Local Health District for a permit to construct <br /> onstru ct and Install the work herein <br /> described. This application Is made In compliance Ith Count Ord e No. 549 and existing Rules and Regulotlonss: <br /> JOB ADDRESS/LO TTION ...?...0. ... . ....................CENSUS TRACT .............-........... <br /> Owner's Name <br /> ..........Phone .17J./.�r-Z4._?,9_ <br /> Address ..,........... <br /> ---------- <br /> --- ......... .. city .......... ................. ........ ...... <br /> 20, ..... ------ <br /> Contractor's Name -p&7-: nse #�_ --------_--- Phone . <br /> Installation will serve: Residence Apartment House 0 Commercial OTraller Court 0 <br /> Motel [3 Other--------------------- <br /> Number of living units:...__ Number of bedrooms .2—. ..Garbage Grinder ------ Lot Size <br /> Water Supply. Public System and name ...;_�.........._........................... ........­­­---------I...........I---------.......... ....Private <br /> Character of soi I to a depth of 3 feet: S6cl 0 Silt E] Clay -[I Peat 0 Sandy Loam 0 Clay Loam, <br /> Hardpan 0 Adobe�Fill Material ------------ If yes,type ..--•-----...•• ............ <br /> Mot plan, showing size of lot, lo'c ation'of-system Ah"relation to wells, buildings, �etc. must be placed on reverse side.) <br /> .. A, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size................................................ Liquid Depth .......................... <br /> Capacity I--------------- .... Type .................... _---------_-- No. Compartments ........................ <br /> Distance Ito,necr_e_st: well ... ................. :---..Foundation ----------_--- ...... Prop. Line ...................... <br /> I <br /> LEACHING LINE No. of Lines,_----------------- Length of each line----- ......... .... Total Length _,........................ <br /> 5- <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> 4 ? <br /> Distance to nearest: Well ........................ Foundation ............_......... Property Line ........................ <br /> SEEPAGE PIT Depth. ......_............. Diameter ------_-_--- Number ............................. Rock Filled Yes 0 No 0, <br /> Water Table Depth -...... -------_------ ............. -------Rock-giie-7.1........... ----------------- <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ....... -------------- <br /> REPAIR/ADDITION(Prev. Sanitation .Permit ---------------------------------------- --- Date .......... _--_---_-_--- <br /> e- <br /> Septic Tank (Specify Requirements) JC ............. ....... ............................... ....................................... ... <br /> 4S t <br /> MZ7saf eld (Specify Requirernjes) 7 .................. <br /> --------------------------------,...._..--••--------------------•----- -- <br /> 14P <br /> ........., <br /> _0 ------ --- - - - - ------------ <br /> ........... ------- ...47,c� <br /> ----------•--------- ...... ----- ---:'n-- -------- ---------------- --••----------•-------------- ------------------------------- ------------------ <br /> I-'Ibrow 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 licen. <br /> sed agents signature certifies the following: <br /> "I certify that in the perF"or once of the work for which this permit Is Issued, I shall not employ any person In such.manner <br /> as to beco e subject t kman's C mpe ation flarl of California." <br /> Wo <br /> XZ W: <br /> Signed --- r <br /> By ----------------------------------------------------------- ----- --- -------- -------- - <br /> (If other than owner) Title ... ------------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY lop, DATE — -------074_ <br /> BUILDING PERMIT ISSUED --------------•-----------­--- . ...... ................. ........ -------f----------DATE --------- -- <br /> ---- ----------_ <br /> - <br /> ADDITIONAL COMMENTS ............4-----____ ------------- ...............I--% - <br /> # ------------- ---- --------------------------------------------------------- -------- <br /> ------------I---------------_-------------------------------------------- -­--------------------- ...........................I...... ........I---------_---_-------I------ <br /> ------------------*­........ *----------------------------- . ­� e <br /> ------------------------------ ------------ J --­-------------- <br /> ---- --------•---------•-••------- - --------- ..... ...............................................- ----- <br /> . ....... .... <br /> final Inspection bY. ........... Date ..............------- <br /> EH 13 2h 1-6.8- Rev. 5m i i <br /> S N JOAQUIN LOCAL HEALTH DISTRICT <br /> 8/7h 3M <br />