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"APPLICATION FOR SANITATION PERMIT Permit No. 2K-..411,?% <br /> (CompletolnTriplIcaft) .4 <br />........................................... This Permit Expires I Year From Data Issued Date Issued f�.:.. <br /> .......... <br /> Application Is hereby made to the Son Joaquin Local Health District for a permit to constnkt and Install the work herein <br /> 4 described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION ......VAe. <br /> ..............CENSUS TRACT .......................... <br /> Owner's Name .......................................I............................. <br /> Address1 ........................... City ................. <br /> Contractor's Name ,. --- <br /> t Llcens�."g."Zl�"......2--.. P h a n a <br /> ----------- -------------------- <br /> Installation will serve: Residence WApartment House C] Commercial OTraller Court r <br /> Motel []Other............................................ <br /> Number of living unit::............ Number of bedrooms ../A.....Gorbage Grinder ­......... Lot Size ............................................ <br /> Water Supply: Public System and name .....------•---------•-••--........_......................................................................private Eq- <br /> Character of soil to a depth of 3 feet; Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom (] Clay Loam E3 <br /> Hardpan C] Adobe 0 Fill Material ............If yes,type ............... ............ <br /> Mot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse slcle.N� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Ispvalloble within 200 feet,) <br /> i4 <br /> PACKAGE TREATMENT SEPTIC TANK f -4. ........ Liquid Depth ......................... <br /> Capacity Je P P-4d.Aype ... ----------_--_----- No. Compartments __�........... <br /> Distance to nearest.• Well ....IAO�............. ...Foundation Z,4�!----_--_-.. Prop. Line .................... <br /> LEACHING LINE No. of Lines ............... Length of each line..747................... Total Length ......a............ <br /> V Box ....... Type Filter Material ....Depth Filter Material <br /> ............................... <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................Z%Nli <br /> SEEPAGE PIT Depth .................... Diameter ................ Number ............................ Rock Filled Yes E3 No <br /> Water Table Depth ................................................Rock Size ....................... ........ <br /> Distance to nearesti Well ........................................Foundation .................... Prop. Line .................•--• <br /> REPAIR/ADDITIONIProv. Sanitation Permit# ....................................... Date ..................................I <br /> SepticTank {Specify Requirements) .......................... .................................................................................................I.......... <br /> DisposalField (Specify Requirements) ...................................................................................................................................... <br /> ................................................................................................................................................. ..........­.­....................................... <br /> .........................................................................................................I.......................................................................... .................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be dont In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules.and Regulations of the Son Joaquin'Local Health District. Hem* ownw or liven. <br /> :sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is Issued, 1'shall not employ any person In such manner <br /> as to become subject to Work an's Compensation laws of California." <br /> D,�' Wo, <br /> Signed ... ... ....................................................... ...... Owner <br /> By .................................................................._.................................. Title .11­1........ ....... .................................. ............. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY rme........... ......................................................... ..........�,DATE <br /> BUILDING PERMIT ISSUED .., , . .........�-_.-..;;��ATE ................ <br /> ADDITIONAL COMMENTS .... ... ..... . . . .... <br /> ............I.......................................... ................................. ............................................................................................................. <br /> ...........1...................................................................... ....................I............................ ....................... .............................. <br /> .__..._.........--•....................?52�9.........................I........I............I............I— - ­.............I..... .................... <br /> FinalInspection by: ........ ................I...................­......................................... .........................Date <br /> EH 13 24 1-68 &v. <br /> SAN JOAOUIN LOCAL HEALTH DISTRICT 8/711 3M <br />