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APPLICATION FOR SANITATION PERMIT <br /> FOR OFFICE USE. <br /> ................... (Complete in Triplicate) <br /> ............................ <br /> Date Issued ... <br /> This Permit Expires 1 Year From Date Issued <br /> ............... .......I. ._. ._..._ . ...._.. <br /> Health District fora permit to construct and install the work herein <br /> Application is hereby made to the Son Joaquin Local e with County Orclinance-�N.No.,549 and exiting Rules and Regulations. <br /> described. This application 1 mode in compliance 1� <br /> ?? ��_ � ...........CENSUS TRACT ............... <br /> ----- ----- <br /> JOB ADDRESS/LOCATIO ..11 — - ----------- <br /> . ........ ... . Phone .................................... <br /> Owner's Name ... <br /> ...................... <br /> city .:��.............. <br /> Address <br /> ....... --------License # & .......................... <br /> Contractor's Name .......ev- .... ... ..... .. _;��Phone. <br /> Installation will serve.; Residence Apartment House 0 Commercial []TrailerCourt, 07 <br /> Motel.0 Other --------------------•--.....-•-•-z...... <br /> Number of bedrooms ....... <br /> Number of living units:._._.._.. .5—Garbage Grinder ------------ Lot Size ...... P <br /> ...................... <br /> ----------------------. rivate <br /> 'Water Supply. Public Syste and name ... ---------------------------- <br /> .......... ....... Clay Loam 0--- <br /> Sand El Silt D Clay 0 peat E] Sandy Loom 0. <br /> Character of soil to a depth lir A 3 feet: <br /> Hardpan F1 Adobe-0 Fill Material ------------ If Yls,type ......................... <br /> ah - <br /> (Plot plan, showing size of lot, location.of..system in relation to wells, buildings, etc. must be placed. on,reverse side.) <br /> Jd if public sewer is available within 200 feet?) <br /> NEW INSTALLATION: (N ' septic tank or seep ge pit permitted <br /> TANK tSi .... ..... <br /> .... Liquid Depth <br /> PACKAGE TREATMENT I SEPTIC <br /> 14Z� Materiol__(� .... No. Compartments ......7-—--------- <br /> Capacity Type(f . .... <br /> Prop. Line _5.......... _V <br /> Distance to nearest: Well ...-------:E20-- ................Foundation <br /> No. of Lines ------------ Length-of each line-.---.../............ Total Length <br /> --_2-07JP...............C <br /> LEACHING LINE <br /> ............. <br /> D 'Box Type Filter M;if�rial .,o?.. .....Depth. Filter Materidt <br /> ion 0 .......... Property Line,..,.. ......... <br /> Distance to nearest:-Well._!5r�p...........-.-Fpundat <br /> r3 A_*Number Rock Filled -Ye No C3 <br /> /.2 ". C�iclmete ------- <br /> SEEPAqE PIT Depth ........ fq <br /> wl�l ..... J <br /> ater Table. Depth ................. .............. ....Rock Size ..: ?� <br /> Linei ...5............... <br /> Prop... <br /> Distance to nearest; We ......................Foundation ....../..i <br /> :111 ......... ........... <br /> Prev. Sbnitotion'Permit# .•.--•-.•--••-•- <br /> 1M'.. <br /> ............... —--------------------- Date ------------- <br /> REPAIR/ADDITION(Prev. Sbnitot <br /> 11! . ....................... <br /> Septic Tank (Specify Requirements) ---------- ...:...........:.:^`-----•..................... ............. <br /> Disposal Field (Specify. Requirements) -_-------- ----------------------------- -------------------------------- <br /> ................ ..................... ........... .................. ...... <br /> ------------------------- --------- ............................................... -------- -------- <br /> .................. .................... -------- <br /> . N - ..:�-------............. ------- -------------------------------------. ........ <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 done ih;accordance with Son Joaquin <br /> County Ordinances, Stateiles and Regulations of the Joaquin Local Health District. Horne owner or licen- <br /> 1 Laws, and RuZ.. <br /> sed agents signature certifies the following- <br /> t is issued, I shall not4mploV any' -person in such manner <br /> 111 certify that in the performance of the work for which this permi <br /> as to become subject to I`Irkmans ompensation laws of California."Signed ... .................................­­._., . ....... ..... . . ........ •----•:.... Owner <br /> :11 ............. Title#164_446elo .......... ............... <br /> By _-------- .................................... ... <br /> (if other than owner) <br /> 1 .111 <br /> FOR DEPARTMENT USE ONLY <br /> .0elo- 't; _j , <br /> By . ........ ......... DATE.2.........................•...... ...... <br /> APPLICATION ACCEPTED., .. ..... . ..... . .... .... . ......... ------------- ---------- ------- - ..............DATE .......:......................... .......... <br /> ................. ............................. ......... .............. ........e...... ............. <br /> BUILDING PERMIT ISSUED _-_�............................... ....... <br /> ADDITIONALCOMMENTS ............................. ----------- .......... ......................... ... ........... .........I.......... <br /> 1�li ........ ---------- ...................................................................... ........... <br /> . ...................... ........... ......... ...... <br /> .............................. ........................ <br /> !10 ....................•-......-•-....----....... <br /> ....................... <br /> ...................... ........... .... ..... ...............­­------- ......... <br /> 0 ............. ....................................... ............. ­ , , I=.......... <br /> ....................Date <br /> _............................ <br /> 1,n­s'p­e',c_Inspection - ------ . ...... ....................I........... -••-----•• <br /> I Final <br /> HEALTH DISTRICT <br /> SAN JOAQUIN LOCAL <br /> -4 24 , KAA <br />