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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. _7 ...... <br /> (Complete in Triplicate) <br /> .................... ........ <br /> ........ ................_1....... ................. This Permit Expires 1 Year From Date Issued Date 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 .1.7........ ............. /04_ <br /> ............... ..............CENSUS TRACT ......... <br /> ...............---------------------I------ ...................... Phone <br /> Address <br /> . .. ....... . .......... .. <br /> ... .......................... <br /> ----------------- Cit, <br /> -------------- ------ Phone --- ..................—.1 <br /> Contractor's Name <br /> --------..Liclens6 . ........ <br /> Installation will serve: Residence ❑ Apartment House Commercial E]Tro'iler Court -0 <br /> -------------------- -- <br /> Motdl er . z4�--- <br /> Number of living units:...'- Number of,/bedrooms�-------_Garbage'Grinder Lot Size ......... .................... <br /> Water Supply: Public System and name ............. <br /> ............... =:: ------------------7------ ­-­------- ........................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Clay Loom <br /> Hardpan C] Adobe C] Fill Material If yes, type ...... <br /> ...... .... .......... <br /> (Plot,plan,. showing size .of. lot,. location of system-in-relation--to-:wells,-b'uildings,-etc-rrust be placed .on. reverse side.} <br /> NEW INSTALLATION:" '(No se tic tank or seeage-'�p­it per itte'd if public sewer is avoilabib within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANKSize_-!�... ----------------- -------- ...... Liquid Depth .............. <br /> Capacity ,, <br /> N6._ Compartments .-- -- .............. <br /> Distance to nearest- Well <br /> ------ ------- ------FoundbtVh ...._-Prop. Line <br /> ----------- ........... <br /> LEACHING LINE, No. of Lines --- --- - Length of each Total Length :..........I.......... f1r1 <br /> 'D' 'Box 9 Depth'Filter Material �...... ..............------ <br /> T�p6 'Filtiir Materia[ .. ........ <br /> Distance- to nearest: Well ------....... Foundati6n Proper Line .. ................... P <br /> Property <br /> Z=rAUE PIT <br /> Z Depth Diameter, ------------ Number 'N <br /> ...... Rock Filled <br /> Yes El 0 ipo <br /> Water. Table Depth._ ----------------- ....Rock Size <br /> ----------- <br /> Distance to nearest: W611 ........... ............ ...Foundation ... ....... .. Prop-.' Line ...... <br /> REPAIR/ADDITION JPr6v. Sanitatio6 Permit* <br /> ...... ............ .......� Date ....._...........-...- <br /> j Septic <br /> ............... -Septic Tank (Specify Requiremerits) .............. ...... <br /> ------------ ....... <br /> Disposal Field -(Specify- Requirements) A-1- - - . . .......... <br /> .................... ----- - ....... <br /> .................... 7---------- <br /> .. <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 donein accordance!with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or Ilion. <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 mann& <br /> as to <br /> -kr"rils Compensation lEw- <br /> become subjiif fo Wor <br /> ,gi <br /> Signed ..... ....... ...... <br /> ...... .. ----------------- --------- Owner 't <br /> ......L-............. ............. ................. ------ 'Title ............... <br /> (if other than owner) <br /> 7=5_71 <br /> FOR DEPARTMENT USE ONLY L <br /> --. / I <br /> APPLICATION ACCEPTED BY DATE <br /> ..........­­------- - ----------------I........... ................. . ...........DATE ... ........... ........... ....... .. <br /> BUILDING PERMIT ISSUED . ­­­.' 7 ........ <br /> ADDITIONAL COMMENTS .................. <br /> ...................___....... ------- ....... ------ ....... --------- -- ----------------­------I............ .............................. -------­...... <br /> ...................... ------- ------------- .................................. .. ........­._­­................. -------------_----- .............. ..................... <br /> Final Inspection by. - ---------- ------- <br /> Date .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.'H.1-3 24 1-'68 Rev- 5M 7 171 1 V <br />