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-X <br /> & <br /> 47 <br /> FOR OFFICE USE, FOR OFFICE <br /> Z: <br /> PLICATION FOR SANITATION PERMIT <br /> .............................. ..................... <br /> (Complete in Triplicate) Permit No. <br /> . .......................................... .............. <br /> Date Issued_,fn <br /> ............... ............. .................... This Permit Expires'I Year From Date Issued <br /> ".:Application is hereby made to the Son Joaquin Loco'l Health District for a permit to construct and install the work herein described.' .! <br /> is application is made in complianca with County Ordinance No.549 9 <br /> and existing Rules and Regulations. <br /> CENS�J <br /> JOB ADDRESS/LOCATION...... <br /> ..................ZV..... ...................... <br /> 'S TR CT.. ...... <br /> Owner's Name...... ........................ ...... .......................:..........................Ph,ne.�9,R37. <br /> - . <br /> A d City e—� Iv_ ............ Z <br /> . <br /> N <br /> Contractor's N a m e..4.49.1." 416:516,� ......... ...... ....... ...... Lice.,. ............... . <br /> Installation.wilt serm Residence% Apartment House E] Commercial ial Trailer Court <br /> Motel C] Other............. ...... .................. <br /> Number of living units:..:. ..........Number of bedroom�....3...Garbage Grinder............Lot Size..�.......... ....... <br /> ,'.--Water Supply. Public S stem and name.. ....... . <br /> . Private <br /> e.0 <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay[-] Peat 0 Sandy Loam E] Clay Loam <br /> Hardpan Hord Fill Material.....--. ....If yes,type.. ......... <br /> Adobe <br /> plan, showing size of lot,'Iocation of system in relation to wells, buildings,etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No 'septic tank or seepage pit permitted if public sewer is available within 20G feet,) <br /> PACKAGE TRFATMENT SEPTIC TANK Size.. .................�..-..Aiquic; Depth.:.0 �-­%+� <br /> CapCcity/ .........Type <br /> c)o! <br /> . ... Material..........................No. Corl!pjg en <br /> ........TypeF Aotei rtrn encs .ice,.................... <br /> est. ........................ .....Founclation..a.0.. ..........Prop. Line.'/.&V........__0 <br /> , <br /> LEACHING LINE- No. of Lin,s..,.2 .. <br /> - <br /> Distance to nearWell..I L.#...................Length of each line 1- ,9rr.V27 .....Total:Length, 49! it�. . ........ <br /> j <br /> D' Box/........Type F0teri ------ <br /> V-4 e <br /> pth Filter Mate <br /> 0) ................ <br /> erty. f <br /> .................Foundation ......... Prop <br /> Well.AAD <br /> Distance,to nearest. atio <br /> Linea 1 <br /> SEEPAGE PIT L Depth... No. L] <br /> Depth--------- ------Diameter Diameter:�,�.......... ....Number........ Rock Filled 'Yes 0 ' <br /> .................. <br /> -Rock Size'.'.". <br /> Water.To'ble.Depth..... .......................................... ............... ................. <br /> Distance to nearest.Well._='........................ . .......Foundation------------- ..........'Prop. <br /> ! REPAIR/ADDITION (Prev:,So n itatior. Permit <br /> Date.... <br /> . <br /> A, <br /> --!Septic Tan ............ <br /> k fSp!cify Requirements)................ ........................................................................................... ........... <br /> ,,,,.Dlipos6l Field (Specify Requirements).................... ------------ .................. ................ ............................. ..... <br /> . ' <br /> ............................... ....... ................ ........ ............................................................... <br /> ............. --------- <br /> W <br /> g--­�ar -----------------------------­- ....................................................I.............I...............I................................................ <br /> (Draw existing and required addition orf reverse side)' <br /> hereby certify that I have prepared this'application and that the work will be 'done In accordance with Son -,fnty <br /> :-t ,;Orcllnah'cos,- State...Laws, and Rules and Regulations of the 'Son Joaquin Local.Health Distv.d. Horne owner or licensed agents <br /> onatum certifies.the following. <br /> th manner�as: <br /> a performonce'�fjh*'work for which this permit is Issued, I shall not employ any person In such <br /> C of in ih fi <br /> orkm Compensation laws of California." <br /> Signed . . .. . .............. ......................... Owner <br /> '777 <br /> .............. ............................................................ .........Title................................................ ------ <br /> '(If other than owner) <br /> Ng DEPART ENT USE ONLY <br /> --- . . .......... . <br /> APPLICATION ACCEPTED BY..,)Q-, <br /> —------------- .....................DATE .... .. . <br /> '----DIVISION OF LAND NUMBER...................Ae <br /> ............................................... ................... ......DATE.......---........:.,..f............_........... <br /> ADDITIONAL COMMENTS.....................I............... -----------------­-------- <br /> -------------------------- ......... <br /> W <br /> ...............................I............................................ ............................................ ........ .................... ........................................... <br /> ..........:......................................... ----------------- ......................................................•.._ <br /> ...............................................r.................................................... <br /> ..... .................... ......­... . ..... <br /> I...... <br /> ............ <br /> .........I............ <br /> Final Inspection by:............. ........ .. ...................................I...::....-•....................:..:.Date...... ........... ...... <br /> EN 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> &S sierra 76 3M. <br /> e <br />