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F1 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ..........................z------------------------------ Permit No. 7/_-5_7-2� <br /> . ................../ - ------------------ lCompleth hi Telplitate) Date Issued <br /> 4 This Permit Expires 1 Year From Date Issued <br /> . /7_�.. <br /> F ............. <br /> Application is hereby made to the Son Joaquin Local Health District for -a permit to construct and install the work herein <br /> I <br /> described. This a ppl icati p litirin-with--County-Ordinance-No.--549--and-existing-Rules and Regulations. <br /> JOB ADDRESS/LOCATION ....Zna/al---------------CENSUS TRACT --------------------- <br /> Owner's Name, --------- - Qa/------------------------------------------ ------------------------------------:Phone ------------------------------------ <br /> Address ...............i.e62c, ...... ...... city ...45c,: Iaw------------------------------------------- ......... <br /> Contractor's Name ..... ------------------------------------ <br /> License# ----------_----------- Phone .............................. <br /> Installation will serve: Residence(ErApartment House-[] Commercial C)Trailer Court C] <br /> Motel 0 Other--------------------•-•-••--•-----._........ ,,qq <br /> Number <br /> -------------------_------------- <br /> Number of living units:--/-------- Number of bedrooms __Z------Garbage Grinder �t&.. Lot Size .... ........ <br /> Water Supply: Public System and name ----------------------------------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet.. Sand 0 Silt C] Clay [j Peat 0 Sandy Loom fEr'-_Clay Loam j] <br /> Hardpan E] Adobe C) Fill Material ............ If yes,type..................... ...... <br /> _N, <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) oar <br /> NEW INSTALLATION: (No septic tank or seepa e pit permitted if public sewer is available within 200 feetj Ll �/_ <br /> PACKAGE TREATMENT [ I SEPTIC TANK T7 Size_-____-_-___----- -- ------------ -- ------- Liquid Depth ..._74m........... <br /> Capacity _gip <br /> %.._44. _t.. Material_i��./_ No. Compartments _._.:Z- <br /> ------------ <br /> .......... <br /> <jV7,, Distance to nearest. Well ........................Foundation ........... Prop, Line ..... <br /> , <br /> LEACHING LINE No. of Lines ---------- Length of each ............ Total Length ---- <br /> a_,�i ne <br /> V Box Type Filter Mate /--� .. <br /> . <br /> Material ..Depth Filter Material -------- <br /> �e­­-,'' 0 6, e . ....................... <br /> ----------------ow---------- <br /> F Distance to nearest: Well .......%:�V---------- Foundation ---/6.............. Property Line. .....6............... <br /> w. <br /> SEEPAGE PIT Depth,. --------------- _.,_Diameter ................ Number ............................ Rock Filled Yes E] No C] <br /> Water Table-D6pth ..... ---------i--------------------------------Rock Size ------- ........................ <br /> Distance td nearest. Well .............fquLn ... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation PermIt# ............................................ Date ...... ........................... <br /> SepticTank (Specify Requirements) -------- ------------------- -----------------------1-�.­..................­­...............................I-------------------------- <br /> Disposal Field (Specify Requirements), -_------_-_--------------------------------------------------------- _­_.:----------------------------I.............. <br /> ------------------------------------------ .................... .............. ----------------------------------------------------------------------------------------1--................... <br /> -------------------------------- ....... ..................­-------�_­---------------- .................... -------------------------------------------------------------------- <br /> (Drdw-exist-i'n6-,on—d=,e—qul,-�id-�i�cfi�ic-n on reverse.side) <br /> I hereby certify that I have prepared -trhif application and that the work Will. be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules-and-Regulations-of theLSdWJoaquin Local Health District. Home owner or licen. <br /> sed agents signature certifies the foilo_wfng_:_- -- - <br /> "I certify that in the performance of the work for which this p;iimIt Is Issued, I shal I'rsot,.em ploy any person In such manner <br /> as to become sub' orkTV!!)?s Compensation lawsrof California." <br /> Signed ner <br /> ---------------- -------- Ow <br /> B - ----------------`----------­`.............. --------- Title ---------------------------- =4....................................... <br /> (if other than owner) - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED rBY .................... ............ ......... "gee ..... DATE ..... . ..P.1-.---.------ <br /> BUILDING PERM-IT-iSSUED ... ...... <br /> ......................-------------------I= -- --- ....... <br /> ADDITIONAL COMMENTS- /------------- . ....... ......................... <br /> /�W�--------- ---------------------------------------------- <br /> -----------------­---------- --------- 7----------------- ...... .................................•------............I...... .................. <br /> ---- ---- ----------- <br /> ----------------- ........ -•--••---------------- ... ...... . .....................q............................................................................... <br /> ........ .........4....... <br /> ------------------ <br /> . . . ................................. <br /> ----------------------------------- - . . ............ . ... . ...... -------••........ <br /> Final Inspection by: ...............Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9- 1-'68 Rev. 5M <br />