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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete Permit No.�77E. <br /> mpleto in Triplicate) . ............ <br /> .......... ........ ............. <br /> ...... .............. .4A ... ............... This Permit Expires I Year from Dotip Issued Date Issued ..................... <br /> Application is hereby made to the Son Joa <br /> for a. permit to construct and Install the work herein <br /> described. this application is made int Ila a Ith Co ty Or once o. 5450 and existing Rules and Regulations- <br /> 2, <br /> JOB ADDRESSAOC TION,//--/A). ..... .......CENSUS TRACT ... ................ <br /> Owner's Name _.Phone ... ..................... . ....... <br /> Address .............. <br /> Contractor's Nome --------- .........License# ..... .................... Phone . <br /> . _ %K�.. --- <br /> Installation will serve: Residence4g Apartm t 'use 0 Commercial ElTraller Court fj <br /> r c <br /> Motel (3 Other MFF-eic/... <br /> Number of living units:...ra_ Number of bedrooms ""-_0_ Garbage finder Lot Size 12-F lk/igf 'I <br /> .................... <br /> Water Supply. Public System and name ............................................... Ij ...............Private 0: <br /> 0 r_1 c <br /> Character of soil to a depth of 3 feet. Sand-E3-. Silt 0 Gay [:) pact 0 sandy Loom 0 Clay Loom <br /> Hardpan 66, Adobe 0 Fill M6terlal ............ if yes,type........ .........1. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION- No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT7 .1 j , <br /> SEPTIC TANK �Jze..57/... ............................... Liquid Depth ............ <br /> Capacity ---- TypeP1mX_dAA Material No. Compartments __-_Z_. _..- <br /> Distance. to nearest: Well ........4.Foundation ._....Z d. ..... Prop. Line .......S.-------_. <br /> LEACHING LINE No. of Lines --- - _-------------- Length Qf each- ........ Total Length ..... ...... <br /> 'D' Box ------- Type Filter Materiol0y-,LAI�...Depth Flit r Material ..... <br /> ................. ........... <br /> Distance to neorl;st. Well N-PAE--------- Foundation .... 0 <br /> . ........... Property Line ..........4......._... <br /> SEEPAGE PIT -__,_Depth __A.4.'-....... Diameter ...... Number _1........... Ro k Filled Yes <br /> .7......... YK NO <br /> Water Table Depth ..... ............ <br /> ----------Rock Size ....... <br /> 4 <br /> ,)�90A' !R/ADD Distance-to nearest: Well _..JAQSAjE..................Foundation _1 .. ........ Prop. Line ......... DD <br /> ...... <br /> ITION(Prey. Sanitation Permit# _.__..:......._.-•-------------------------- Date ...4.............................. <br /> ,.Se ptit Tank (Specify Requirements) ••• ..................... ................................ ......... <br /> ..........................-••------••............. <br /> Disposal Field (Specify Requirements) ........... ---------I.............9........................... -------------------------------------------------- <br /> - ------------I----------_-- ------------------_- ---------------- <br /> .......................... ..................... ..................................................................I....... <br /> ------------------- I <br /> -------------I—------------------- .................... <br /> ------­­­­--------------*........................................ ............................. <br /> (Draw existing and required 6cidition on reverse side) <br /> I hereby certify that I have prepared this application and that' the work will be done In accordance with 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 work <br /> ,for'which this permit Is Issued, I shall not employ any person In such manner <br /> as to become subjl�� Work an's C ponsati laws of California." <br /> Signed -- ----=. 4 <br /> By -•-------------------•--------....__......_.._..- <br /> ertonooner� <br /> ........... - ------ -------- Title <br /> (if other than owner) <br /> It RTM T INF,ON <br /> By <br /> APPLICATION ACCEPTED BY ------- ....... DATE ....... <br /> �U <br /> .. .................... <br /> BUILDING PERMIT ISSUED ....... DATE . .... ......... <br /> -------------------- ------------------------------- ------------- -------------------------- . .......................... <br /> 5p*,nsc,,b., <br /> -------------- -- -------------------- ------- ........................... ---------- ........ ....... <br /> ADDITIONAL COMMENTS ......... ------ .................... <br /> -----------­-------- ----------------------------..-,."---"-•...............•-- ----------- ------------------------------------------ ---------------------------------- ------;---------- -- --- --- ------ <br /> ........­----I ---- k�� -------------------------------------- <br /> -----------------*------------- <br /> -------_------------------ ---------- ---- ------ --- ----- <br /> Final Inspection by: ..... . .I.. ..... <br /> .........."-•...............Date ........ <br /> EH 13 2L 1-68 .Rev5m <br /> -V SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />