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WOE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .................................. ...................... <br /> ... ....... <br /> Komplol*In Ti4plicotol Permit No. Z�. ... <br /> ................................... 1111 - <br /> ...... ................... ........................ irhls Permit Expires I Year!crane Date issued Date <br /> Application Is hereby made to fhe Son Joaquin Local Health District for a permit to constrict and Install the work heroin <br /> described. This application 'Is made In compliance with County Ordinance No. 549 and existing Rules and Regulotionst <br /> JOB ADDRESSAOCATqN ....... .. . ........ ... ..................................................... .............CENSUS TItACT .......................... <br /> Owner's.-Name ....... ...... .. .. <br /> .................­2... .....................................Phone . ...... <br /> ,kddress . ...................... .. ... . C'. <br /> .... ......... Q <br /> -ro-, 1= — -.5! - -.... Phone ...... <br /> V... ........P ......... ........................................ <br /> Contractor's Name ' ,'-... <br /> installation will serve, Residence 0 Apartment House 0 Commercial OTraller Court ❑ <br /> Motel [I Other........... ................................ <br /> Number of living units- Number of-bedrooms .......Garbago Grinder ---- Lot Size ............................................ <br /> Water Supply: Public System and name ................................. <br /> ........ . <br /> ........................ .................Prmft 0 <br /> Character of soil to a depth feet: Sand El Silt(3 Clay .0 Peat 0 Sandy Loam iE] Clay Loam 0 <br /> Hardpan[J Adobe Fill Mater'I'a"I ............If yet,type............... ............ <br /> Mot plan, showin9 Size of lot, location of system In relation to wells, buildings, etc. must be placed an revertsside.) <br /> 11 <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I <br /> Size............ ................................... Liquid Depth ..................... <br /> 6pacl+y .................... Type .................... Material..........................r-No.--Compartments ..................... <br /> Distance 'to nearest,-Welles ...............:..................,Foundation ...................... Prop. Line .................... <br /> TEACHING LINE t I No. of Lines •........................ Length of each line. ........ Total Length ........................... <br /> V ............ Type Filter Material ................... Depth 1011ter'. Material ...................... .................... <br /> h <br /> Distance" to nearest, Well ...................... Foundation ............. ........... Property Line ....................... <br /> SEEPAGE PIT, ........ ............................ .hock Filled Yet t3 No <br /> Water 1*61* Depth ...............................................Aock Size ................................ <br /> Distance to nearest: Well .... ........................... .......Foundation tt�...... .......... Prop. Lino .........». ..... <br /> ... ....1� <br /> REPAIR/ADDITION(Prev. Sanitation Permit 0 . .................. . .... .... . ....... .Date .............................t....) <br /> :i / L-1- <br /> Septic Tank [Specify Requirements) )-C e, ". .... .. .. ......... ...... <br /> mentsl .......... <br /> • <br /> D;sDosal Field (Specify Requirements) rw- .. ..... -------------- <br /> .............................................. <br /> . ..................................••--....,....__.I..------------........ ... .............. ...................................................... 7 <br /> .................... ............I........ <br /> .................................... ..............I....................­*............ .....................................-................ <br /> (Draw existing and required addition on reverse side)' <br /> I hereby codify that I have prepared this application and that the work will be done In accordance with Son Joaquin <br /> County ounty Ordinances, State Laws;!and Rules and Regulaflons of fhe Son Joaquin Local Health District. Home owner or Ilcon• <br /> sod agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> gnec .............. ............ Owner <br /> By .... <br /> ......................:4-itle .......... <br /> ......... .ad ......*.......... .......... ................. <br /> ...... . ........ <br /> 114i�e=rthan W ad <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....'7 , ....... ...... .. ... ... .. ... DATE <br /> BUILDING PERMIT ISSUED ....... .......... �.............. ..........-----­-----------........... .......DATE.......... ------_-_---_---------- <br /> AR,PITI NAL r <br /> 0 OMMENTS ................ <br /> -7- ................... <br /> ....... A . ... ....................... <br /> ............�I.............. .. ... <br /> .......... ... .. . <br /> .. . ............ .............. .......... ..... .................... ...... ...... ....... ....... <br /> ... ....... ...... ............................I.................. .. .... . ..... <br /> !� <br /> Final Inspection by. s.........1__­�. . . .. . . ....... .... .................. ------- ----------------- ..........Date ......... <br /> EH 13 2h 1-60 nev. 5H :f <br /> SAN JO ,QUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />