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FOR OFFICE USE: <br /> ...................................... <br /> APPLICATION FOR SANITAY110N PERMIT........... <br /> Permit No. .......I...... <br /> (Complete In Triplicate) <br /> AiAle -2.7. EN <br /> ................................... This Permit Expires I Year From Date Issue <br /> Doti Issued <br /> Issued <br /> Application is hereby J made to the Son Joaquin Local Health District for a permit to construct and install stall the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCAT� Nzl (j CENSUS TRACT <br /> �-t _6"e� <br /> . .................0................1-11,............. ...... ................... <br /> Owner's Name --------ec ---------•-•---•--•.•-------•.,....,... <br /> Address ....... ........... ... ... ---------F_:City ..........................I. .........-•--- <br /> Contractor's Name ................ ..................License#2SY-,�Y-1..... Phone 4 ...PO-7........ <br /> Installation will serve: Residence 0 Apartment House JE] Commercial OTraller Court 0 <br /> Motel []Other.......................... .................. <br /> Number of living units: ...... Number of bedrooms --_.....Garbage Grinder ............ Lot Size ...... ........ <br /> ............... ...............-------- .............. ............... <br /> Water Supply: Public System and name ....._.....Private 0 <br /> Character of soil to'a depth of 3 feet. Sandr] Silt[] Clayo Peat[] Sandy loam Ej Clay Loam <br /> a <br /> Hardpan 0 Adobe Fill Waterial ............ If yes,type............... ............ <br /> 47 <br /> U) <br /> (Plot 'plan, showing-size,of lot, location of system In relation towells, buildings,,, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public-sewer-is avollable within 200 feet,) <br /> PACKAGE,TREATMENT f ] SEPTIC TANK I Size-----------------------------------I............ Liquid Depth .................... <br /> Capacity ---- --------- Type ------------------ Material...................... No. <br /> Compartments .. ................... <br /> Distance. to nearest: Well ----------------------------------..Foundation ..__....__.....5....__ Prop. Line ...................... <br /> LEACHING LINE.. No. of Lines I........................ Length of Length ............................ <br /> V Box ........ . Type Filter Material ..........:.::'....Depth Filter Material ............................................ <br /> Distance to nearest. Well ................ Foundation ............... Property Line ........................ <br /> SEEPAGE PIT, Depth --------------------- Diameter .............- Num—be'r. ........................... Rock Filled Yes 0 No <br /> Water Table Depth ------------........ ..............n-koick Size .......................... <br /> Distance to nearest: Well ................... .......-...foundation .................... Prop. Line ........... .......... <br /> ........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......... .............. ................... Date ................................... <br /> Septic Tank {Specify Requirementsj ------ ............ <br /> I �%y---------------- ..... ... <br /> (Specify Require & <br /> Disposal Field I[Spe' Requirements) .... ......4- �,!........ ---------------------- --------------------------- <br /> ....................................................... ................. <br /> ............................-.............w------ ...... ....... <br /> ------------------------------ ------------------------••-------_--------- -----------------------------------...-.•-.--•---......... ..................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that ! have prepared this application 'a( nd'tha' t the work will be done In accordance wilh Son Joaquin <br /> County Ordinances, State Laws, and Rules �and Regulations of the Son Joaquin local Health,District. Home owner or licen- <br /> sed agents signature certifies the following:. <br /> "I certify that In the performance of the"-W' 0'rk for which this pennit is Issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------- ------------------ --------f <br /> �.._...._•-------------11-11-1:----------- Owner <br /> By ................ - --------- --- --------------- litle ..........4 -15 . ......-.......... ........ ................. <br /> -::7_2 <br /> (If other owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ......... <br /> BUILDING PERMIT ISSUED .... ...... ... .ct4-1-------------------------------------------- DATE.----•----DATE ------------------------------ <br /> ADDITIONAL COMMENTS ----- ------------ <br /> . ...................... ................................ ....... .---•----------•-------•-----...---------------•----•---•--.... <br /> ---- ------------------I--------------------- --------- ------I------------------- ............................................................—.......... ....... .................... <br /> .......... <br /> -------------w......... ----------------- ----------;-------------------------- ------- ------------ -------------------- ................................ ------------- <br /> --------- ------------------- ---------------------------.............. ........ <br /> - ---- - - ------- ----- -- -- - - -- <br /> Final-Inspection by: -�'- -,,-*----- il--------- . . . .. ..................-........ ............ ......Date`.. ... .. . .. . . ........... <br /> ---------------W <br /> EH 13 24 1-68 Rev. 5M or I/. <br /> AN JOAQLIIN LOCAL HEALTH DISTRICT A 3M <br /> f <br />