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FOR OFFICE USE: <br /> ......................................................... APPLICATION FOR FOR SANITATION PUM Permit No. ...22-jg�✓3 <br /> .................................................. (Compleft In Triplicate) <br /> ...... .......................................... This Permit Expires I Year From bete InoW Date issued .7a .... ..�F <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construd and install the work herein <br /> described. This application Is mods In compliance with County Ordinance No. §49 and existing Rules and Regulatlonst <br /> ...........................I.......................... .......................... <br /> JOB ADDRESSA "' * - 1 011-� <br /> -- X44 ...�!�- a <br /> N ....me ...................4 . <br /> ................................................... ........ .......Phone .................................... <br /> ................................a <br /> ............. ty ....................................... <br /> Contractor's Name ....... .................................License# <br /> Installation will serves Residence R''Apartment House(3 Commercial C)TMNW Court E3 <br /> Motel o Other............................................ 6 <br /> Number of living units:.. ..... Number of bedrooms ..../V....Garbage Grinder ............ Lot Sire ... ...3.............. <br /> Water Supply, Public System and name ....................................................................................................privateem- <br /> Character of soil to a depth of 3 feet: Sand E3 Silt 0 Clay [3 Peat 0 Sandy Lem 0 Clay Lawn[3 <br /> Hardpan❑ Adobe)W Fill datwial ............If y4e,type........................... <br /> !Plot plan, showing size of lot, location of system in relation to wells, buildings, oft must be placed an reverse side.) <br /> NEW INSTALLATION: IN* septic tank or seepage pit permitted if public sewer is available within 200 feet,! <br /> PACKAGE TREATMENT SEPTIC TANK(A)--- 120 ................... Liquid Depth .............. <br /> Capacity ..... Type ....... No. Compartments, <br /> ................... <br /> 0- <br /> Distance to nearest: Well ......... .....................Foundation. ...I .......... Prop. Line ....o?. ..... <br /> No. of Lines ............... Length of *04 . ......... <br /> LEACHING LINE IT .. . ........... Total Length ...... <br /> V Box ./........ Type Filter Material �:A-eT...Wpth Filter Material ..........Ig <br /> .................................. <br /> <7c-/ :5- r <br /> Distance to nearest: Well ........ Foundation ... ............. Property Line ........................ <br /> IN, <br /> SEEPAGE PIT Depth ...9.-S......... Diameter 34........ Number ........c;.2............... Rock Filled Yos)w No 0 <br /> C17 01 f I/ <br /> Water Table Depth .....1X0e—............................Rock <br /> ­­7**--..........Rock.011se....(;X... ............ <br /> Distance to nearest: Well ..... . ...................Foundation .. 3-T <br /> ......................Four 14� Prop. Line ..................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .......................... <br /> SepticTank (Specify Requirements) ................................................................................................................................... <br /> DisposalField (Specify Requirements) ...................................................................................................................................... <br /> . ................................................................................................................................................................................................ <br /> . ..................................................................................................................................................................................................... <br /> (Draw existing and required addition an reverse ddef <br /> 1 hereby cwflfV that I have prepared this application and that the work will be rear la seewdoma with S" Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Me" Distdct.Home owner or licen- <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 no employ any person In such manner <br /> as to b** su GO t1rWark jAen's Compensation laws of California." <br /> );gnec! .................... .......... ............... Owner < <br /> By ..... ............ .... ....... Title ....— ................................................ <br /> (If other <br /> .r than ow 6r; <br /> FOR DEPARTMENT, USE ONLY <br /> APPLICATION ACCEPTED BY ......�'4COee. <br /> ............... . . <br /> 7 .......................... ...... DATE .... . ...... <br /> BUILDING PERMIT ISSUED .. . / DATE;........................................... <br /> ADDITIONAL COMMENTS .... ..... . ........................................................................................ ........ .....I. ................................ <br /> . <br /> ............... ............................................................................................... .................................................. <br /> ........... ...I.................................................................................................................. ............................ ................... <br /> ..... .. ............. ..... ........I................................................................................... ....... ................................... <br /> . . <br /> Final Inspection by: ....... .............. ...... �� ............... <br /> .............. <br /> EH 13 2h 1-68 Rov. 5m SAN JOAQUIN LOCAL,HEALTH DISTRICT 8/7h 3M <br />