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APPLICATION FOR SANITATION P1 <br /> 1............... ................... ----------- (7 " ?7 <br /> Permit N <br /> 1 o. ._ ._"l <br /> (Complete in Triplicate) <br /> I........*...............*.................. ...... 77 <br /> Doti Issued ........ ........... <br /> .................. ................ This Expires I Year From Dal*Issued <br /> .................... <br /> Application is hereby made to the Son Joaquin local Health District for a permit to construct and Install this work herein <br /> ii <br /> described. this application.Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> R <br /> JOB ADDRESVLTION ....... ..... .... .....CENSUS TRACT ........ ........... <br /> Owner's Name ........ . ............................................ ... .......... ......... ........ <br /> Address :. �ffk .7 city . <br /> ... ................................................... <br /> Contractor's Nme- ----- ---- License # Phone ............... .............. <br /> Installation will serve: Residence(Apartment House jj Commercial Ol Court 0 <br /> Motel 0 Other. .......__-1......................... <br /> Number of living units:.-.__-_:- Number of bedrooms 3...Garbage Grinder .............Lot Size .... .............. <br /> .. . ....... ......... <br /> Water Supply. Public System and name ---- <br /> .......................................................................................... .....private <br /> Character of soil to a depth of 3 feet- Sand E] SIltEj Clay Pel Sandy Loam,0-----Clay Loam,tj <br /> Hardpan El ' Adobe E] Fill M6terlol ............ If yet,type .............. ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. Must be placed on, reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit perms If public sewer is available within 200 feet;) <br /> PACKAGE TREATMENT I ] SEPTIC T Liquid Depth ................. <br /> .......... Na. Compartments ....... .......... <br /> Capacity Type Material...... <br /> Distance.to nearest: Well . u...................Foundation ....X A.......... Prop. Line ....:I............... <br /> t1V <br /> LEACHING LINE fjNo. of Lines --------- ----------- Length of each line. ......... Total Length ...�A_ <br /> ........... <br /> D' Box ..... Type Filter Material ......Depth Filter Material ................................ <br /> Distance to nearest. Well ....... Foundation ........ Property ............. <br /> SEEPAGE PIT t 1 Depth -------------------- Diameter ----------; _.. `Number ............................. Rock Filled Yes 13 No 0 <br /> A Water Table Depth ......... ......................................Rock Size ................................. <br /> Distance to-nearest: Well ...Foundation ............. Prop. Line ...................... <br /> REPAIR/At)DITION(Prev. Sanitation Permit ............................................. Date ............................... <br /> Septic Tank (Specify Requirements) ........... -------- ------I........... ....................................... ............... <br /> Disposal Field (Specify Requirements) ...... ......:...----••-••-•-•--•--•...... ............._.............. ...... ...............I.............. <br /> .................:.................................'...•--. --------­--- ......................... ........ ................. ................................7......................... <br /> ------------.................................................................. --------------------------------------;.................................................................. ................ <br /> A Prow existing and required addition on reverse side) <br /> I hereby certify that I have prepared this applitaflon and that the work will be donein accordance with Son Jol <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:011strid. Hayne owner or 1111cer, <br /> sed agents signature certifies the,following- <br /> "I certify that In.the performance of the,work for which.this p"mit is Issued, i shall not employ any. person in such manner <br /> as to become subjett to Workman's Compensation laws of California." <br /> Signed ............. --------- 1 ... ­ -• -- <br /> BY ------ ----- ......­-- ---- Yjtle .- ...... 4 <br /> ..................... <br /> (if other than owner) <br /> FOR ,DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .....................•----..... DATE <br /> A - . <br /> A EBUILDING PERMITASSUED ............ ............... ....................I-----._...._....-- --- . ................................. .... ...... <br /> ADDITIONAL COMMENTS ..----------•-----.............. .. ­ .. .......... <br /> .. <br /> ---------------------------- ------ ----- -------- --------------------------------------- ....... ....... ............. ............ -------- ----­..... .­­­':------------------�.­----------- <br /> - ----------------------------------------- ........ ------------------------------------------------------------------------------ ............... -------------------------------------------------- <br /> ------------------------- ............... ... <br /> ..a..... -r ........... . . ..............•---------------•---............ <br /> Final Inspection by: ------------- 1 _e .............................. ..........Dat , ­y ­ . ­ - <br /> ....... <br /> EH 13.2h 1-68 Rev. 5m SAN JOAQUIN LOCAL HEAtTH DISTRICT 8/7h 3M <br />