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FOR OFFICE.USE: <br /> APPLICATION FOR SANITATION PERMIT 39'/-7 <br /> Permit No. _7�........... <br /> ...................... ..........*....................... (Complete In Triplicate) <br /> .......... .........w................. <br /> Date Issued <br /> This Permit Expires I Year From Date. Issued <br /> .............................. ------- <br /> Application is hereby made to the Son Joaquin Locai Health District for a permit <br /> mit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existi.ng,Rvles and Regulations- <br /> ACT ........ <br /> .. . .. ........................................CENSUS TP <br /> JOB ADDRESS/LOCATION '-A <br /> - 1,7— ,.............. ........Phone,... <br /> Owner's Nome ..... ........... ...... ................ .............................. ................................. <br /> ity <br /> ................. <br /> .................. <br /> Address .........V5-w --------------- ....................... ..................... C <br /> Contractor's Nome _­11,cense Phone <br /> ------------ <br /> Installation will serve: Residencep Apartment House'O'Commircial Trailer Court 0' <br /> Motel C].Other ......I........I............................. <br /> Number of living units—/------ Number of bedrooms .=-......Garbage Grinder .10.0..efk Lot Size ........... <br /> Water Supply. Public System and name -------------------------------------------- .............W_............ ----------............................Private <br /> Character of soil to a depth of 3 feet.. Sand r] Silt[_] Clay 0 Pe.at 0 Sandy Loom-0 Cloy Loam <br /> Hardpan C] Adobe rV1 Fill Moterial ............ If yes,type ............................ <br /> (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc, mist'be placed'on reverse .side.1 <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT, [ ] SEPTIC TANKP i%0a..zX..o...................:Liquid Depth r .................. t\ <br /> Capacity/,9&P...... Type//.O;K,/4 1e,7 ... Material _4W�Z_�.... No. Compartments -—------------ -14 <br /> Z - 4-1 <br /> Distance to nearest- Wd.,-Zo....... .................Foundation ......... Prop. Line,,.e.,;.r/............. <br /> LEACHING LINE No. of Lines ..../................. Z ............ <br /> Length of each li ­ad............• Total Length <br /> J <br /> V Box Tyiie Filter Material/0�_,I.?e�epth Filter Material X� ------ ....... <br /> SIt.......... <br /> ........ 9......--•... Property Line <br /> Distance to nearest: Well .... Foundation I <br /> . <br /> ? /K. Number ..... ........... <br /> - .... Rock Filled Yesk No C3, <br /> SEEPAGE PIT Depth OZ�........... Diameter .... .... .... <br /> Water Table Depth ......... .......................Rock Size ................................. <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...... ...... -------------r............... Date .... ............................. <br /> Septic Tank (Specify Requirements) .......... ........._.. .---.....--• ....................... . ........................... <br /> 0Z 7— ��z <br /> Disposal� Field (Specify Requirements) ....t�; <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 accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or Ilcen- <br /> sed 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 betofne subject to Workman's Compensation laws of California." <br /> Signed ...................... . .. ........... owner <br /> .. ..................... . ...... <br /> By .............................. ................... ............ <br /> I ?it h <br /> f at than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ... <br /> APPLICATION ACCEPTED BY ..,er .........................I.................... DATE -47.7 ... ........ <br /> BUILDINGPERMIT ISSUED ............... ............ ............................................................. .............DATE ........................................— <br /> ...................... ................ ................................. <br /> ADDITIONAL COMMENTS ........4..._........ .......................... ------- <br /> .......... ...................... ...............v............................................................ ------------- ................................­­­......... ........ <br /> ....... ........ ............... .........;......I................................. <br /> ............................... ................ ........... ------ ---------- <br /> . <br /> ................................... ..........M... .........;r. ....... ...... <br /> ........................ ....... ....... ----------------------- <br /> FinalInspection by: ...... ...............................................................Date .. ..... .......... . ............... <br /> SAN JOAQUIN.-LOCAL-HEALTH DISTRICT <br /> r- u 13 24 -1 -AD D- XAA 7/72 3-X <br />