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t <br /> FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT <br /> sc .......... ........... . ICenntplele In TriplkeM <br /> Permit No. <br /> y.y <br /> This Permit IIMWT e 1 Year Fret Do%lssaed Dcft owed ..!-,:1 _7` <br /> Application is hereby made to the Son Joaquin local Health District for a per,, to construct and install the work het_irt <br /> described. This application is made in compliance with County Ordinance No. Sig and existing Ruhr and Regulations <br /> JOB ADDRESS/LOCA .n - <br /> Owner's Nome ��..... �......»_...... ......ep.. ......»_ TRACT `e..y.�....»....._ <br /> Address �_��. .�/f .. ..-Pltotte....... .»...... ........ <br /> ...._.. <br /> Contractor's Name .... ..',E�I jy »._...,...»................_. <br /> Lioaae//��3f'� . _ Phone ...»...................... . <br /> Installation will serve: Resid Apartment How" Coewrten W Oftro"W cow O <br /> Motel C]Other »._». <br /> Number of living units: ) Number of bedrooms ..- Y Q <br /> .Garbope Grinder ........—. lotSi><e .---•..,,�9----_........»... <br /> Water Supply: Public System and name . <br /> .»........................_..........Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay peat <br /> ❑ Sandy loam ❑ Clay loam ❑ <br /> Hardpan Adobe❑ Fill Material _- If yes, <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse ) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENSEPTIC TANK j ) Size.........................__.-».. .. liquid Depth ........ ....... <br /> Capacity .................... Type .................... MaierW...»................. <br /> No. Compartments <br /> _.....» %t•� Distance to nearest: Well . <br /> ^ ti <br /> .................F undetksn ......... ...._ Prop. Line........ <br /> ...»..»..». <br /> LEACHING LINE O No. of Lines . .. length of each line.. .. -. ... Total length .........................D' Box Type Filter Material ....................Depth Filter Material <br /> Distance to nearest. Well ......_......_..»...... Foundation property <br /> 'f SEEPAGE PIT .................... <br /> Lino ........................ <br /> O Depth Number Rock Filled Yes ❑ No 0 <br /> P Diamefer ................ <br /> Water Table Depth ................. ..........Rock Size <br /> Distance to nearest: Well ................. Foundation <br /> ` REPAIR/ADDITION Prev. ...................__ .................... Prop. line ...................». <br /> ( Sanitation Permit#.....................•..................... Dots j <br /> Septic Tank (Specify Requirements) .... <br /> ---- <br /> ---- <br /> _.---- <br /> __--__....................._- <br /> Disposal Field (Specify Requirements) ._......... -..-...»....» <br /> c�tet, ....-.....1. ..�.... ..( - - -;_ �. �......:►-.»» <br /> ---J..----.... <br /> row existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will bre done in accordance with Sen J*aquln <br /> County Ordinances, State laws, and Rules and R*guhstions of the Son Joaquin Local Health District, Het* owner or licen- <br /> sed agents signature certifies the following: { <br /> "I certify that In the performance of the work for which this is"mif is Issued, I shall not*mpley any penen its such rnamnw <br /> as to become subject to Workman's Compensation laws of California.,, <br /> Signed .......................................... Owner <br /> By .................................. . +-tZf7 <br /> - <br />