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' FOR OFFICE USE ` <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit ��/ <br /> (Complete �vm�n � p|ina+m .� `" -..��c �_ <br /> ---------------------------------------------- <br /> ThisPormit Expires I Year From Date Issued Date issuedApplication is hereby made <br /> i <br /> to the Son Joaquin Loco|Heo|H, District- for o permit to construct and install the work herein <br /> described. This |ication is made in complia' ncew. N�, <br /> . 5A9 and existing Rules and Regulations: <br /> -------------------------------------- <br /> Contractor's Name ------------ -- ~`'~~ s= `, Phone -.--__-'___ <br /> |nsta|lation will serve- R si6on e portment Houe�D Commercial :E]Tra||er Court � <br /> Motel Other ----- -----------' ' <br /> Number of living units:-. --�� <br /> -. Nvm6a, of bedronmv ~A~^~.Go6bogo Grinder — ' Size ------- <br /> Water <br /> ' --` ------VVotexSupply. Public System and non,e --_-_—�_-----'_--'—_-�'-'—' Private <br /> ' <br /> ` _-'---_'—.� <br />' [konac�, ofsoil o,odepth of3fent: 3ond�� Silt[] Clay Peat E] Sandy Loam E] Clay Loam <br /> Hardpan [] ` Adobe-E] Fill Material --�--- If yes, . ---'--'--.. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side,) <br />� NEW (No septic tank or seepage ph permitted if pw�� sewer is available within 200 �e') <br /> / <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ Size------------------------------------ ---------- Liquid Depth --------------------------- <br /> Capacity <br /> --'—'__-CopocityType ��o��r�� N� Compartments <br /> [------ ------.. -------� . ---.----' . <br /> Distonce to nearest: Well ------------------------------------Foundation ---',----.- Prop. Une ---.^-'_._ `* <br />� <br /> LEACHING LINE [ ] No. of Lines -----_- k <br /> Length of �uc� ne�-----.----- Tu� o/ Length -._--__'_ ' <br /> . ' ' ~ <br /> D' Box �------. Type Filter Material --------------------Depth Filter Material -._—.—_'-'-'-'''-- » � <br /> Distance xz nearest: Well ----- -------------- Foundation -------- Property Line -------- <br /> SEEPAGE PIT [ } Depth ---�--'-- Diameter --._- Nom ` , �--� �_-'---.. Rock Filled Yes �� No �] <br /> . <br /> ` <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to <br /> ------'-'—'Cxstonco *z nearest: Well --'--'—_'| un6uf�n --�..-.--' Prop. Un* -------- ----­------- <br /> - i ^ <br /> mm (Prev. Sanitation Permit# -------- -----------------------------. Qotm.~.._-''��.~...�� -` <br /> I (Draw existing.and required addition on revere6 side) <br /> ' hereby^ certify that . have prepared this mpp;/cmnoo and that nnw work'wiu-be'mwnm :n mm*on*wnce with Son Joaquin � <br /> County Ordinances, Smatemnd Rm|my and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed <br /> ' <br /> wed pgents signature certifies the following: <br /> "I certify that in the performance Of the work for pv6|c6 this permit is issued, U shall not employ any p=rwwu in such manner <br /> as to be*w �i t v Workman's Compensation U of California." <br /> 1 <br /> � <br /> �~ Ufo*ho, �hon ovvn�i � 0/ ����������Signed n g <br /> --- TH <br /> ----------------- <br /> ----- <br /> . FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED ' ~ - ------'--'--- <br /> __.____._-___—___----____..--------------- DATE <br /> ADDITIONAL COMMENTS ---.- ''`'`'�`--�--'-`'--- <br /> -----'�----.------'-----.--'_--=�--------------_---'_--.------- <br /> ----------------------------------------------------- ' <br /> � ----_-7:-=��-,-- <br /> ',_- <br /> _.—_---. y <br /> ---' <br /> ---_—'--_- - -_-----.—'— -'- ---''Fino| |nopecnonby: ----' Do^e~ ------------ <br /> - <br /> ''�—' <br /> �.---._� --'��� '—'-- - - ---'- <br /> 3AN ]OAQU|N LOCAL HEALTH DISTRICT <br /> ` <br /> ' <br /> E. H. P l''68 Rev. 5M <br /> .� � ' <br />