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TOR-OFFICE USE: <br /> .t, APPLICATION'FOR SANITATION PERMIT <br /> ---------- - <br /> -------------------------------------- - '. 1. ;,\ Permit No. <br /> -W.,. -- .&, (Complete in Triplicate) <br /> --------------------------------------------- <br /> ------------------------------------:!--------------- This Permit Expires 1 Year From Date Issued Date issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is fnpd <br /> Spjj�eompliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ------- ---------------------------- ------------ -- -CENSUS TRACT -- --7--------------- <br /> r5 <br /> ----------------------- --------- <br /> Owner's Name -- Phone/-- <br /> Address -----------ZS�6�?_15;7-------- <br /> /PA <br /> ---------------1.�----------- city ......5 <br /> -------------- <br /> ContractoA Name _- ✓ ----------- -------License # -------- ------------ Phone ------------------------------ <br /> I <br /> Installation will serve: gesiclence43rApartment HouseE] Commercial :oTrailer Court i,171 <br /> IMotel F1 Other -------------------------------------------- <br /> Number of living units. ------ Number of bedroom's --i,-:2�_-Garbc�ge lGrinder A__�o Lot Size _7K�- /.7-c7--------- <br /> Water Supply: Public System and name ------------------------------------------------------------------------- -----------------------------------Private El <br /> I <br /> Character of soil to a depth of 3 feet. Sand'E] Silt F] Clay E] Peat E-] Sandy Loom [3 Clay Loam,0 <br /> Hardpan E] Aclobe!Z Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sicleil-� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT Size_ ___q <br /> SEPTIC TANK,j- ' I- !� - _5 ----------- Liquid'Depth ------------------ <br /> Capacity Type aterial_ VK� o, Compartments ---------- <br /> Distance to nearest., Well ------- -- --------------Foundation.'-- --- Prop. Line --------- <br /> LEACHING LINE <� <br /> No. of Ll'es ----/----------------- Length of each line -------- Tota] Length -----Z---q_a_1------- <br /> 'D' Box --- Type Filter Material ___,o0F_0 61�Depth Material ----- __"!___\_____________________ <br /> r--- - I <br /> Distance to nearest. Well ----- Foundation __4!�F-----4f-------- Property Line --- ------------ <br /> Diameter Number ----- --------------- Rock filled Yes Ap No C] <br /> SEEPAGE PIT Depth --- <br /> Water Table Depth ---------------------=--------Rock Size- <br /> I , -+- e,- , , , T <br /> Distance to nearest: Well ---14:5p 0------------------------Foundation - Prop. Lir64 ---3------ -------- <br /> REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------I------- Date-------------------------------- <br /> k . , r, - - <br /> SepticTank (Specify Requirements) ------------------------------------------------------------------ ----------------I------------------------------ ---------------------------- <br /> Disposal Field (Specify Requirements) -------------------------------------------_r_--------L----------------------------------------------------------------------------- <br /> - <br /> -------------------------------- ----+----------- -------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition 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 Districi.'Ho-me owner or licen- <br /> sed,agents signature certifies the following: - - . I <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 o Wor7ka 's Co&ensation laws of California." <br /> -0 <br /> Signed --------------6571-1-------'1_10/ -----------------------------------------`Owner <br /> By ------------------ ------------------------ -------!- ------- Title ------------------------------------------------------------------------ <br /> (if othei than owner) <br /> 1A 6��041D_EPAR_TMNT USE ONLY <br /> APPLICATION ACCEPTED BYDATE <br /> - - ----- - ----------------------------------- ---------------- --------------- <br /> - -- ------- <br /> BUILDING PERMIT ISSUED --------- -17------ ------------------------------------------------------DATE ------------------------------------------- - <br /> ADDITIONAL COMMENTS ---------- --- - ----- -- ------- ------------- --------------------------- ---- --------------------------------------------------------------------------- <br /> - - <br /> --------- ------- ------------------------------------------------------------------------- <br /> -- --- --------------------------------7---- <br /> --- ----------------------------- - ---------------------------------------------------------------------------- - <br /> ----------------------------------------- <br /> --- ---------- ------- -- ------------------------- --------------------------------------------- <br /> --- <br /> --- <br /> -------------------------------- ---- --------- <br /> ------------I------- <br /> I Pcr ---- //- ��---------------- <br /> -----Date ------ <br /> Final Inspection by 7V!------------------- ------------------------------------- ------------------------ <br /> ...-SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />