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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .............I---------- --_------------------------ <br /> ...... m <br /> .......... lCoplete In Triplicate) Permit m0. 7 <br /> ...................... . <br /> I . Doti Issued <br /> P................................... ..... This Permit Expires I Year From Do#*Issued <br /> Application Ts-,h—er q-"yode to the Son Joaquin Local Health District for a permit to construct and 'Install the work <br /> ersin <br /> described. This fir <br /> ation is made in compliance with County Ordinance No. 549 and existing Rules and Regulat16s. <br /> JOB ADDRESS/LOC N <br /> '...CENSUS TRACT ------------ ........ <br /> .... .............. <br /> LOCA <br /> .. ...... ........ .................................................................. ....... <br /> Owner's Name ----- - <br /> Ph ff 7. <br /> "n <br /> Address ... ....... ------ - - <br /> ... .. . ------ ....... city <br /> - ------- . .. ... <br /> .......... ............... <br /> Contractor's Nome . A <br /> --- ------- _- ... <br /> .... .....e- ...... ........................License # ..... ... -3-_..., hi <br /> 4-A J <br /> Installation will serve. Residence O(Apartment House mmerclal OTrall uit <br /> 0 <br /> ��Motel-O-Other7:-T..�...........� �Z4 --I <br /> r., ............ ........... <br /> r-- i I <br /> Number of living units:-.-/--- Number of EeQiaoMs....!:3.=Garbage Grinder ...... . ............... <br /> Lot Size .........4��. . � <br /> ..............................................Private <br /> Water Supply: Public System and name ....... ....... <br /> -Character of soil to a depth of 3 feet: Sando Silto 00Y-0�-Peatq: � Sandy Lbam-0—Clay Loom <br /> . .1 1.- Ar� 1�1 I I , I <br /> WT--Hordpon-C]—Aclobt 0 Fill' ' *" <br /> ..... If yes,type .... .......... ............. <br /> Mot plan, showing size of lot, location of system In relation, i� <br /> � we s',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 TANK <br /> ...................... Liquid Depth ............. <br /> Capacity <br /> Y Type .... No. Compartments .................J, <br /> Distance. nearest: Well Sp -r- f- <br /> ..............Foundation ... .... .4��.... Prop. Line .. ........ <br /> LEACHING LINE No. of Lines . .... <br /> ...... .i?� <br /> .............. Total Length . 79................ <br /> .. . ------- Length of each line- <br /> D' Box ... Type Filter Material _ -----'..Depth Filter Material .......................... <br /> otAd-nearest, Wel ..... Foundation .... Property Line . ........ ......... <br /> SEEPAGE PIT Depth .... ............... Diameter .... Numller ..................... ...... Rock Filled Yes C1 No C] <br /> Water Table Depth ------- ........................I.Rock Size ................................. <br /> Distance to,nearest: Well.............. ..........................Foundation ............... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------t-__--_---_---_---_. ate ..................................I <br /> ntsl................................. .....................I <br /> Septic Tank {Specify Requirema <br /> ............ ........ .................................. ...................... <br /> Disposal Field <br /> ............................ <br /> ----------------------------------------------------- <br /> ----- ----------- --------------------- ........... ...... ...... <br /> ----------------- --------- ................ ............................ ........... ...-•----•--•-••----•......----- <br /> '(Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application'and t_W_k6t;AIwo Ill be done In accordance with Son Joaquin <br /> t A- <br /> County Ordinances, State Laws, and Rules and Regulationfof�the!San Joaquin Local Health,District. Herne owner or licen- <br /> sed agents signature certifies the following: -',E 11 1 <br /> "I certify that in that 06-rFormance of the work For'which this Is ormit'is i <br /> s...d .! <br /> I-I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of CaIIMrnL;._.1 <br /> )Aw k.0 <br /> Signed ------------- --------- --------- -------- 17�-------- ------­----------------_ Owner <br /> By ................... . ... --- <br /> Iothe th ner) -------------­----------- Title .......... .......... ......... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Y -------- --------_--------- -------------------------------------------- DATE ..... <br /> BUILDINGPERMIT ISSUED ----------- - --------- ------------- ------------ •---.._...._....._.-----•--------- - ............DATE ...-...... ........................ <br /> ADDITIONAL COMMENTS . - ---------------------------------- <br /> -- - --- -- ---------------.._---..---•........ -------....---....---...........__._..:.......•--................. <br /> ............................. ................ <br /> - -------------------- --- ----- ------------- <br /> ----------- ----------------------------- --1.................................... <br /> ------------------- ---------- 0- - ­­ ----------------------------- ...................... <br /> - ------------ <br /> -------------- ------ -------- ..... -------- ............... ...............Date <br /> Final Inspection , - .- n/ :7 <br /> EH 13 L 24 1-68 Rev- 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />