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FOR OFFICE USE. <br /> ................... ........... APPLICATION FOR SANITATION PERMIT <br /> 0 1co Permit No. - <br /> .................•.......••----••......._...__• ....... mplete In TrIplicatel ... .. ........... <br /> ............... .............................. This Permit Expires I Your From Date issued Dat6 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 /> JOB ADDRESS/LOCATION........................... 18-7-2_&...E_Ztia..................................._._CENSUS TRACT ................ ......... <br /> Owner's Name _.FxgAk._A1Xine .................... Phone ............................... <br /> Address .............................�187� ................................ S t 0 a R,Uo"]a'........ <br /> ...............•--•--....._...........--- ...... .........— city ....................­........................ <br /> Contractor's Name ---RP!q..B2.2ter Swer Ser. License # Phone 27�539 ...46G--.2-6n....... <br /> --------------------------------------------------------------- ................. ......................... <br /> Installation will serve: Residence El Apartment House 0 Commercial oTraller Court.. <br /> Motel 0 Other <br /> Number of living units:_ ........ Number of bedroo• 3... <br /> -f_-(?fftq rd. b0 by 1 5 0 <br /> Water Supply: Public System and name ............ 'Taft <br /> Griner Lat Size <br /> ..................._­---.............................7....... ......Private 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom a Clay Loom 0 <br /> Hardpan 0 Adobe-b Fill M6terlal ...no._._ if yes,type <br /> ............... ........... <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 feet,) <br /> PACKAGE TREATMENT 11 SEPTIC TAMC `I Size.................:..........•--......__....---•=`Liquid Depth ..................... <br /> Capacity ---1­............. Type ------------- <br /> ...... Material...................... .No. Compartments .................00 <br /> Distance. to nearest. Well ............ <br /> ..Foundation...............:...._.Prop. Line ...................... _J <br /> LEACHING LINE Na. of Lines -----_------- ........ Length of each line................ <br /> ............. Tot6l Length ....................... <br /> 'D.' Box ............. Type Filter Material ----------4.........Depth Filter Material .................. . <br /> Distance to nearest: Well ------- ................ Foundation . <br /> . <br /> . <br /> . <br /> ...... ...I <br /> 1 ... --- Property Line ...................... <br /> SEEPAGE PIT Depth ..-------------_-.. Diameter ....... Number ............................. Rack Filled Yes [I No C)00 <br /> Water Table Depth ---------------- ----•------- .................Rock Size .......................... <br /> Distance to nearest: Well ......................... ....... Prop. Line <br /> ......Foundation ............ ---- ------ <br /> 11. ... ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit --------------------------------------------- Date .=--.....---- <br /> Septic Tank (Specify Requirements) ---_------------------­­­................... <br /> Disposal Field (Specify Requirements) --------- ............... <br /> ---and---1-3-31-bY­25!----Pj­t­.............. <br /> ---------­--------I------------­---------------------------------------------------:-----------------------------------------------------------------------------------1----- <br /> I - - , , ...................... <br /> ----------------- --------------------------------------------1 --------------------•---•-*------------ ----------------------------------------- ......... ............... <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 Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:Distdct. Hattie rt <br /> e owner or lice • <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 become subject to`Workman's Compensation laws of California." <br /> Signed ------- ........ <br /> ----- --------------- <br /> --------- *-- - ------ ---- ---- --------------- Owner <br /> By --------------------------- --- 7-7 Contractor <br /> ----------- litle .... <br /> ............... <br /> (If 0 than owner) <br /> 0 - . <br /> FOR DEPARTMENT USE ONLY. <br /> A PL D By <br /> PPLICATION CEPTED BY <br /> BUILDING PERMIT ISSUED ........--- -- - -- --- - - - - --- ------------- <br /> ---------- -------- ---------- ------- DA <br /> ----------------------- ------------------------- ---------__----------_------ ..............DATE ........... ............... <br /> ADDITIONAL COMMENTS ................ ---------------- <br /> ........... ......... •............. --------------- <br /> .......... -------------------------------------I--- ------------A-------- ------ ----------1­-------------- ......... <br /> -------------­­­­------ ------­------------­ -----------------------.-_.__.-•.............................*.................*------- <br /> ................ <br /> ........... ---------------------------- ............... .......... ...........I......... <br /> -----------­---------_--- <br /> -------------- -- ---- ------------ ..............­­­.................. ------ --------- <br /> ------------­ <br /> Final Inspection by, ------- - - <br /> ----------------------------------------------------------------------------Date <br /> EH 13 24 1-68 1?ev. 5M - -,/ �/7. .. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT V8/7h 3M <br />