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APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: <br /> (Complete in Triplicate] Permit No.7iVf46 <br /> ................ 3!7 <br /> ....... --------_J This Permit Expires I Year From Date issued Date Issued.. / <br /> Ocation is hereby made to the Son Joaquin Local Health District for a permit to construct and install-the work herein des <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: cribed. <br /> J06 ADDRESS/LOCATION.... <br /> ....... ..........CENSUS TRACT___------ <br /> Owner's Name. <br /> ---------------I---------------_ ............. <br /> - -------------- ­-­--------- --------------- <br /> Address........ r;2. i Phone..._................................ <br /> .... ........... <br /> .....�­,­­ ........ ........."..City <br /> . .. <br /> .... ...... ........ <br /> Contractor's Name....__,6�4' <br /> License' <br /> ............ 3 2- <br /> Phone-_........ <br /> Installation will'serve. Residence J!­Apartment House❑ <br /> Commercial -Trailer Court ❑ <br /> r. :..Motel f3,--'Other::.............. <br /> N4umber of living' units:.__..__.. _._.__Number of.bedro <br /> oms. <br /> A --- _------ <br /> e <br /> (at r Supply: Public System and name-.­,,.-,--.,.,-,.... - - <br /> ------- -------- --- <br /> .......... ------ ........ ------Private <br /> -haracter of soil to a depth of 3 feet: Sand ❑ Silt[] &Ipy-0— Peat D Sandy Loam Clay Loam rl, <br /> Hardpan 7 Ad6be:E]­!"tFfIIWaf­r1`I--' ,—If yes,ty <br /> pe................. <br /> --- ------ <br /> N6t pla,n, showing 'size of lot, location of system jn're1at_!on to___"well "�Mlcllngs,I etc. 'must be p(ciced on reverse side.) <br /> s, <br /> IEW INSTALLATION:* (No septic- tank k `.o r Seepage pit permitted if public sewer is avail aible within 200 feet,) <br /> -ACKAGE TREATMENT ; SEPTIC TANK . Sk <br /> Size*---------------------------------*--,-,:..........­!_.Liquicl Depth_....... ....... <br /> .......... <br /> Capacity;.._ --_-------- Moterial...-•.......... ... . !Compartments.-......:-No. Cornts. ' <br /> . . . ........... ....... <br /> Distance to nearest:. ell.,,, <br /> ................... <br /> Prop. Line.......... ........ <br /> -EACHING LINE No;,of LI: t, <br /> ries...... '._Jotal Length_.............. <br /> ......Length of each lin'gN...---- ---- <br /> 'DBox._:___. ._:.Type Filter Material;------------ '_._Depth Filter Meter'al------_Z.................. ------ <br /> Distance to nearest;Wei I-' <br /> .............•---.Property Line.-:....... .................. <br /> Depth....... <br /> AGE PIT 17 1" <br /> ......_Vlarneter. ....Number_ <br /> 4------­--­---- --------- Rock Filled Yes❑ No E) I <br /> .....---••'............ <br /> _�'Water Table-De <br /> ------------------Rock Size.----_---.............................. <br /> bistanc6'to neo rest:-V411 <br /> I-------I .............. Foundation--•- -------------_d._.Prop. Line----... <br /> ......... ......... <br /> 'PAIR/ADDITION (Prev.Son itatio' n-Permit#. <br /> - -------------------- -------- <br /> .. ....... . <br /> -ptic Tank (Specify Requiref-A <br /> .......... <br /> ............ <br /> ....................... ------........... <br /> spwal Field (Specify Requirements)...... A• _ <br /> .. ................... --------- ........... ...... <br /> ae----_---------- <br /> ..... ..... <br /> ------_----- <br /> ---------------------------------------- <br /> ----------------------------------- <br /> .................................. ......... ............. ......... ...... <br /> ........... <br /> (Drowixis'ting and te'qu-ii4id-add <br /> 0 <br /> *reby certify that.1 have prepared this-application and that the-work -will be done in accordance with Son Joaquin County <br /> dinances, State Laws, and Rules and Regulations of'-the: Son Joaquin Local Health District. Home owner or licensed agents <br /> mature certifies the following; <br /> g: <br /> certify that in'the performi:ince' of thi, work for which this p'ermfi"Is'iis'ued, I shall not employ any person in such manner as <br /> become subject to Workinan's Compensation' <br /> laws of California. <br /> ned---------*. <br /> .......... <br /> .............. .. .. ... .......... --------- <br /> a--------------- - ----------- Owner <br /> . . <br /> . I ........ ..._Title... <br /> '(If other than owners <br /> ' <br /> . D..E..P..A..R....T....MIN <br /> T <br /> LSE-ONLY)­ <br /> • <br /> SLICATION' ACCEPTED <br /> BY....... .. C............................... ................. <br /> (OONAF LAND NUMBER---.--.:- <br /> UMBEV... ...................... <br /> .. .. .. = ----••••. ...... ........... <br /> DATE <br /> .­.7OL COMMENTS............. . ..................... <br /> ................ ------- ...... ...... --------------------- <br /> .................... :. , , I" ................... ............./ <br /> ................... ........ <br /> .............................. ...... <br /> ............ ............ ...... ------------ <br /> ------- <br /> -------------- <br /> ---------------------- I - , .. t= :.­?�L <br /> ........... ....... ............ -------I-----:f.. <br /> ............... ........... ........ <br /> ................................ -------- ........ . .4, ? <br /> .4-------- -- ------- <br /> --------­---- <br /> .......... .. ........ .......... .........by:. _..__. .. <br /> ji Inspection <br /> 3 24 <br />