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FOR OFFICE USE: APPLICATION FOR SANITATION PLgtMrr Permit No. <br /> (Complete In Triplicate) <br /> ................................ <br /> . ................................. ................. This Permit Expires I Year From Date Issued Date issued... 7 <br /> Application is hereby made to the Son Joaquir. Local Health District I permit to construct and install the work herein <br /> Ordir <br /> nce <br /> described.This application is made In compliance with CountyNo. 549 and existing Rules and Regulattlonst <br /> ................... <br /> JOB ADDRESSAOCATION CENSUS TRACT ... <br /> Owner's Name ff <br /> ... ......... ......phone ................................... <br /> ....... ... <br /> Address -.... ..... ................. City .........I....... . ___........ ............. <br /> Contractor's Name--........ .....................�Aloenso*....................... Phone ............................. <br /> Installation will serve: Residence E]Apartment House 0 Commercial OTroller Court <br /> tel E]Other............ <br /> r of living units:..... NALTroof bedrooms .3......Garbage Garbage Size ....29AI <br /> Number Grinder ............ Lot ---------- .................... <br /> opply: Public System and naTe ----- --- .............................. Private <br /> WP ------------*. .........*.................................Private <br /> ZZ. of soil to a depth of 3 feet Sand SlItE] Clay 0 Lo SandyLoarno . Cloy Loam Irdipan C] Adobe E] Fill M6teriol,........ ...if yes,type.......... ................. <br /> (Plot p!on, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> N INSTALLATION: (No septic to k or seepagepit permitted If public sewer is available within 200 feet,)k; Size.............i..................... ....... Liquid Depth .......... ......... <br /> PAC&GE TREATMENT ( ) S AUK <br /> A <br /> 6001:40� Materlialirowoae:... No. Compartments ..A�........ <br /> Capacity Type60 <br /> to nearest: Well ---- -------------------Foundation.. ........I...... Prop. Lim ...... JV <br /> DjNo. of Lines ee, <br /> EAC�IING LINE .............. Length of each line.. g <br /> . <br /> LTstal Lenth ---- ...... <br /> V Box . ... Type Filter Material 5$04,46 .Depth Filter Material ........1A ." ...... <br /> Distance to n6mst! Well -.ZO............... Foundation ..__0............ Property Line JV................ <br /> SEEP*G" -.-- <br /> T-Ilr--Deptft- ALs- = <br /> := Diameter4tW <br /> 'J4 .... <br /> -No.. ....Tf ............. Rock Filled Yes &-�No C1 <br /> Water Table Depth ................ Rock Size................................ <br /> --1A v� ndation ..... Prop. Line <br /> Distance to nearest: Will . I <br /> I� <br /> REPAI <br /> R/AD ta� -I <br /> DMON(Prev. Sanitation Permit#........................................... te ........_.3_...........-..._... <br /> SepticTank (Specify Requirements) ........................................................................ ........................ ------------------ <br /> Disposal Field (Specify Requirements) ........................................................ -------------------------................. --- <br /> ------------------------------------- <br /> ------------L------------------------------------------------------------------------------------------.......... <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 clone In accordance with Son Jectsiuln <br /> County Ordinances, State Lows, and Rules and Regulations of the Son Joaquin Local Health District. Rome owner "41cle- <br /> sod agents signature cortiCes the following! <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ a— Pon" In such manner <br /> as to becom I to Workm <br /> S Camp if*" laws of California." <br /> rr Sig .... ......... ......... Owner <br /> ....*'**' "'**.... Owner <br /> By------- ........... ........................................ ................................ Title ......... ...... .. .........­.... .. .L-------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....100.1rony.c, ................................................ . ..........- DATE ...0777AF:7 .............. <br /> BUILDING PERMIT ISSUED-.......... ...... ................................................................................ ......... ; <br /> ---- ... ... 1............. <br /> ADDITIONAL COMMENTS....._................................................................................... ........-:::.::.::c3_... <br /> . U <br /> ............. ........... <br /> --------- -------------- <br /> ............. .......... -.... .. ----------- -------- - ...............................................................................................I <br /> ...........- .....------- .. ........... . ........................................- .................................-.-............................................ <br /> �:....*.........L*:-- - � ............... ............................ ........ .-*...... ----- ..........no] Inspection y:--------- � .. .. ...................................... ........ .....6�te . a .V........ <br /> . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'68 Rev. 5M <br />