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FOR OFFICE USE: APPLIL*ATiON FOR SANITATION PERMIT <br /> Permit No. <br /> ............................................... (Complete in Triplicate) <br /> --- ------­---------------- 6t <br /> This Permit Expires I Year From Date Issued Date lssued­.��V./:: <br /> -�-��.__ <br /> ------------ -------- <br /> ■ <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------- ......_CENSUS TRACT .......................... <br /> I --- •_.Phope <br /> wner's NWe .........P ............._... ... ....... <br /> 7. .............. <br /> Address <br /> 0 Al <br /> Aor ................I city ------'s-17 <br /> Contractor's Name -------------------_----- --------------- ------------ ................. .......License# ----- ........... Phone .............................. <br /> ♦ <br /> Installation will serve: Residence A.Apartment House,[] Commercial{]Trailer Court C3 <br /> Motel []Other ......... <br /> I&A.......c Y--ps <br /> . .... <br /> _11 . . A <br /> . .. <br /> Number of living units:..../----- Number of bedrooms ..,#-----Garbage Grinder X!ax Lot Size __; .. . . <br /> Water Supply; Public System and name -----_--------------------------------------- ----__...................................................Private <br /> Character of soil to.a depth of 3 feet- Sand U] Silt C1 Clay Peat C3 Sandy Loom E] Clay Loom 0 <br /> Hardpan 0 Adobe;K Fill Material ------------ If yes,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 permitted if pub%c sewer isavailable within 200 feet) <br /> Z .4 N <br /> lir <br /> PACKAGE TREATMENT ( I SEPTIC TANK( ] Size. Liquid Depth ------ ............ <br /> 41 ents ......21.......... <br /> Capacity Type I_0A4_,r!A MaterialC.?.9_070'4�40- jompartm <br /> Fod t <br /> 3,4 ......... Prop. Line I... .... <br /> ,a <br /> . <br /> Distance to nearest: We 7-------- <br /> ....... <br /> LEACHING LINE No. of Lines ? <br /> ------------ Length of each line ----- --- --- Total Length J&------_- <br /> Al' _,/ <br /> 'D' BoxXl�_S---- Type Filter MaterioI /_4x. .....Depth Filter Material _..../f 7 <br /> Distance to nearest: Well ----- a..... i Foundation ---- Property Line. .... ............... <br /> SEEPAGE PIT Depth A�------- Diameter Number ---------?—. ------- Rock Filled Yes No <br /> Water Table Depth .... ..............Rock Size A. <br /> -----------------------_----- 1* ...... . l"e' <br /> Distance to nearest: Well -----/ L....................I' .Foundation Aag......... Prop. Line ...1.4— .– <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............. ....... ------_-------------- Date ---___-_-•---•-_--------) <br /> Septic Tank (Specify Requirements) ----------------_----------_­------------------- --------- ................ ................... ------...... .................... <br /> Disposal Field (Specify Requirements) ......... ---------------------------------------------------------------------------------------------------------------------------- <br /> ................ ................................................................................. ....... ................ ---------_-_---------.................................... <br /> ................. --------------- ................................ ----•----•-_-•------------------------- --------------------------------- ..............................r....... <br /> (Draw existing and required addition on reverse side) with Son Joaquin <br /> I hereby certify that I have prepared this application and that the work will be done in accordance V <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: I shall not employ any person in such manner <br /> "I certify that in the performance of the work for which this permit is issued <br /> as to become suffiect tk Codo s of California." <br /> Signed, . 17... --- .............. Owner <br /> By ---------------------_----___------_- --------- ............. Title ---------- --------------------------------------- --.................. <br /> .......... ...... . <br /> (if other than owner) <br /> FOR .DEPARTME T USE 0 <br /> .. .. .. ...... --- <br /> APPLICATION ACCEPTED BY, DATE -. ... <br /> ------------ ------------------------------- . -----__--------_---- <br /> BUILDINGPERMIT ISSUED -------------------- ---_--------/_............ ........ .... ...........•----..._..._......--.DATE ..... <br /> ADDITIONAL COMMENTS ------- ..... ................ ...... ...... ......I........ -----------•--• <br /> *-------------------------*----------- <br /> ---------- <br /> -----------------_ ........ ......-----------............•- <br /> .............................I)-;,&------------------------------------------------------------- <br /> ----------- .................. <br /> ................................... ­Vt. ...... -- -----.................................... -­-------------- ...... <br /> -- ------------------- <br /> Date -- <br /> Final Inspection by: ------- --- --- ................. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />