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OR OFFICE USE- <br /> ........... ----- APPLICATION FOR SANITATION PERMIT <br /> Permit No. . <br /> ...... (Complete In Triplicate) <br /> ....�­­............................ <br /> L// .15.7. . <br />..............-1...... .................... This Permit Expires'll Year From Dot*Issued Doti issued .. .0- <br /> .. ..... <br /> ,Applicotion1s"hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application is.mqdp.,in,cqmpliance with County Ordinance No' 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ...... ;-; I> <br /> :.... ......................CENSUS 'TRACT ......................... <br /> ' . <br /> , <br /> ...... ....................... Phone ......... ..­­....."......... <br /> Owner's Nome <br /> Address ....... .... city .......... ........ ......PZ�4_ <br /> ----- ....... ....... ........................... <br /> .... . . . <br /> Contractor's Nome <br /> . ..... ... . .........License # Phone <br /> A <br /> lom!'O�Commercial-OTraller-Court-0--- <br /> Installation will server -R s ceApartment <br /> Motel ❑Other .............................,............... <br /> Number of living units:_.I -3---__-_Garbage..... Number of bedrooms . ------Garbage Grinder .,.........1. Lot Size .......F­ <br /> Water Supply. Public System and name ....... .......____.............................................................. ......... .......Private <br /> Character of soil to a depth of 3 feet'.;_. Sand-C3­Sllt-[]-----Cloy--0 —Peot-17-1---Sandy Loom 0 Clay Loam <br /> Hardpan C1 Adobe-0 Jill M6torial ............ if yes,type ............... . <br /> (Plot plan, showing size of lot, location of system In ' <br /> 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 TREATMENT f SEPTIC.TANK[ Size................................................ Liquid Depth .............. <br /> -Capacity r.! Type .......... .... Material............ ......... <br /> No. Compartments .................. n <br /> Distance to nearest: Well ...........-t ...............Foundation ......................- Prop. Litio ..............I...... <br /> LEACHING LINE No.( of Lines. ...._._../.---._...__ Length of each line.----.--- ......... Total Length ..........o0 <br /> 'D'. Box .............. Type Fitter Material ................... Depth Filter Material ................................;P" <br /> Distance to nearest: Well --------- .............. Foundation ................ Property Line ......I............ <br /> r1cr <br /> SEEPAGE PIT.-(��J -��,'D' bpth 4./X:'1_A.4ADiameter _------------- Number .•-- --- ................. Rack Filled Yes.1 No 'A <br /> I <br /> - .Water Table Depth . ....................--------- ................Rock Size .............. <br /> 11 .......... <br /> Distance to nearest; Well .........Foundation .................... Prop. Line ....... <br /> REPAIR/ADDITION(Prev. Sanitation.Permit# -------------------------------------------- Date ....._..._..._..__.-_........_.--.I <br /> SepticTank (Specify:Requirements).-------------------------------------------------------------- .............................................. .................. <br /> Disposal Field (Specify Requirements) .-•-----• ...........­.......... ........ .................................................................. <br /> ...........__----------- --------------------------------------------------------------------------------------- --------I........................... <br /> --.1--------------------- <br /> -----7----------------- ------------------------------------- ­------------........ ---------------------------------------------------------------------4............... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that -1 have prepared this application and that the work will be done In accordance with Son Joaquin <br /> County <br /> Co; Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Nome owner or licen- <br /> sedagents signature certifies the following: <br /> "I certify that in the'performance of: r' <br /> the work for this permit Is issued, I shall not employ any per.son In such manner <br /> as io become subject to Workman's 'Compensation laws of California." <br /> Sig W --------- --- Owner <br /> By ----------- --- - .... . .. .... .............. title ----_------- ------ ......... ........ .................. <br /> (if at t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .............. .. .............. -------------- --------- DATE ----------- ......... <br /> ASSUED _;........ ........... ........ --- - <br /> BUILD1NG 'PERMIT ............ . -------------------•-••. .............. .................................DATE <br /> ADDITIONAL COMMENTS .---------------• __----------- ------•------------------ ------- -- ------------_- -1---------------....._...--------..._._..-.......... <br /> C_ <br /> other <br /> ----------------------------------------------------------------- --------------- - ----------------------------------------------------------------------------------- ------- <br /> ------------------------------------ - - --------------------------------------­­-------------------------­­­......................... ­­-- -------- .. ....... <br /> -------------­.................... ----------- ------------------ ..................................................... •_.. <br /> ---- --- --- <br /> Final Inspection by. ...... .... ..... ..................................-1................. . ........ �ie ... -... ... <br /> EH 13 24 . 1-68 Rev. 5N SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3 .' <br />