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FOR OFFICE USE: a "'APPLICATION FOR-'SANITATION SANITATION PIERMIT r- v Permit No .. a -------- ----- --- ------ ---• -- :-- -�- ""-' (Complete in Triplicate] Date Issued ?� ------------------- - This Permit Expires 1 Year From Date issued --- --------------------------- ----- e work herein ermit to construct and�ins Application is hereby made to the Son Joaquin iancLocal e with CounDistrict Ordinance No. 549 and existing Rules tand hRegulat ons,. described. This application is made in comp 5 _..__� w,..... - - ��! -- CENSUS TRACE -------------------------- JOB ADDRESS/LOCATION -J_ _.I t-c`.��_ ------ y --- ----- -- �.� _C. `--------------------- ----------�--- ----- --�--- ------ ----- -�---- -------------Phone .-------------------------------------- Owner's :-- ----- ------ ------ •--------- Owner's Name ti = Citense # - Phone Address --• - - - License / 7$'-r C, 7 S , F Contractor's Name _ - __ _ ' f Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ,❑ Motel ❑Other -- ----------------------------------------- 6 .I , ' Garbage Grinder•�------ Lot Size ------------- Number --------�- Number of living units: ----- ---- Number of bedrooms - Private ❑ -- - ------•--------•-•------------- Water Supply: Public System and name -- Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand Fill Material _.._- ---_ l yes,type Hardpan E) Adobe F rse side.) (plot plan, showing size of lot, locbtion of system in relation- to wells, buildings, etc. must be placed on reve I k .: NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, • Size---- ------------------- ---------------------- Capacity --- �- ----�- - - - Liquid Depth --------- ---------------- PACKAGE ----- ----.--•-' `nl PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] s - -.- No. Compartments ----------------••---- f Capacity -------------- Type ------------------.- Material---------- --- Iv.f Foundation ----------- Prop. Line IS", Distance to (nearest: Wel! ----------------- -------- -""---" ( r,`. ---------•-----• - LEACHING LINE. `'.[:] No. of Lines _ . Length of each line----------------- -- ---- Total Length -- `p' Box ----i------ Type Filter Material -------------------- Depth Filter Material � � Property Line. ------------------.- SEEPAGE - ---- Distance to nearest: Well ---------------- ------ Foundation __-------------- ------ SEEPA�GE PIT [ 1 Depth ------ ---------------------- Diameter ---------------- Number ------------ -- -------------Rock Filled Yes ❑ No Q ---- ----•----Rock Size -------------------------------- WaterTable Depth ---------- ------------------------------------- I --------------------- - �I Pro Line ---------------------- Distance to nearest: Well ------------------------------------ Foundation P ' ----------------------------------- i Date -- ------ ------- ------ ------- -} REPAIR/ADDITION(Prev. Sanitation Permit# -- ,`� / � - . -- yc� /� vo_ --.,_- ------------------------- Septic Tank (Specify Requirements) -.--- m'L+ " �� ! ----------------- Disposal Field (Specify Requirements) - ---------------- --------------- -- --------------- - --------- ---- -- - - - - - ---- -------- ---- -----------------------"- - (Draw existing and required addition on reverse side) oce t I hereby certify that 1 have prepared this application dthat he San work will be donealth D e in oridctnHo e�towner oh Son r Icenn County OOrdinances, State Laws, and Rules andRegulations sed agents signature certifies the fallowing: mploy any person in such manner "I certify that in the performance of,the work for which this permit is issued, 1 shall not e I as to become subject to Workman's Compensation laws of California." Signed ----- -- ------- --------------------------'--------------------------- .---- Owner ----------------------------------------- BN7it1e ------- ---- -------- (If other than o ner) i FOR DEPARTMENT USE ONLY -( - DATE . APPLICATION ACCEPTED BY ------- . ------ _• ----------------- DATE ---------------------------------- ---------------------------------------------------------------------- f BUILDWG PERMIT ISSUED -------------- ----- - --- -- -"- ADDITIONAL COMMENTS ------------ -""---------------------------------------------------- - --------- ! ---------------- -`---------------- ------------------------------------------------------------ ----- -- - ' : ------- �.� - ------ ------- ---- -------- --- -- �----- -- --- ----- ----,Date ------- - Final Inspection by: � ------------ ------ SAJOAQUIN LOCAL HEAL7.H -DISTRICT. -, E. H. 9 1-'68 Rev. 5M