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FOR OFFICE USES 44LICATION FOR SANITATION PERM*, <br /> .. ...... &................I....................... (Complete In Triplicate) Permit No. <br /> . .. <br /> .................. - - 7/ <br /> ........ Dote Issued ... <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Reputations: <br /> �Ikl( :A��. ...CE TRACT ...................... ... <br /> !OB ADDRESS/LOCA�Pm X.� - . '* - <br /> Owner's Nomq-.-Ak .......•Phone .................................... <br /> .............. ..... . ................................... ............... .... <br /> 1 <br /> .............. <br /> ............:--City ..........................I...... <br /> Address J............... <br /> Phone ........................ <br /> � �LlLfcense # <br /> Controctor*s Name .... <br /> ..11: ..................................... ........ fj.� <br /> r; <br /> Installation will serve- Residence T Apartment House 0 Commercia1 [3Trcsiler Court 0 <br /> Motel0 Other ...... . ....... ........................... <br /> Number of living units:....... Number of bedrooms ....Garbage Grinder .......... Lot Size .... ............ ........... ............. <br /> ❑ <br /> Water Supply: Public System and name -W•. .... . ... ................................ ............ ....Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay (:] Peat[3 Sandy Learn gel Clay Loom C] <br /> Hardpan 7] Adobe ] Fill Material -.......... If Yet,type ........... ................ <br /> ' <br /> JPlot 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 public sewers available within 200 feet,) .4 <br /> PACKAGE TREATMENT [ I SEPTIC TANK V( Size.7LI/I jia."V?.�5..I....... .......... Liquid Depth 44...................... <br /> Capacity Type A*al Material No. Compartments <br /> .......... Prop. Line —:0.............. <br /> Diston— Jest. Well ..........A?!:�...................Foundation <br /> 9.............. Total Length A.0•................ <br /> ,LEACHING UNE lid No. of Lines ....... ............. Length of each line & .. If.0................ <br /> -D- Box .�...... Type Filter Material .......Depth Filter Material ........... ....... <br /> ..... .41P.- Property Line ..'� ....... <br /> 0 <br /> Distance a nearest.. Well ....lay.................... Foundation <br /> SEEPAGE PIT I Depth ... .. ............ Diameter ................ Number .. ........... Rock Filled Yes [I <br /> Water Table Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well .......................................Foundation .................... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dote .................................. <br /> Septic Tank (Specify Requirements) ..... . ......................................................................... <br /> Disposal Field (S:-Pecify Requirements) I............................_.............................................— <br /> ......... ... ............................ ........ <br /> .............................. ...................................................................................... ... .... . <br /> ...I.......... <br /> ..........................................I..............Dr.ow.exi.s I t.i n-g..a.n.d..required.a.dd.i.ti.a.n on reverse si de) <br /> I hereby certify that I have prepared this application and that the work will be don* in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Horn* owner or Ilc&n- <br /> sod agents signature certifies the following: issued, I shall not employ any person In such manner <br /> "I certify that In the performance of the work for which this permit Is <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .... ................ . 1.1.........................I...... Owner <br /> By . . ... . . . .......... .. ..... ... ............... .... ....... ....... Title .. .... .. 1 Z.11.................................... <br /> (if other than owner) 41 <br /> FOR DEPARTMENT USE ONLY <br /> ................... <br /> ............. DATE <br /> APPLICATION ACCEPTED BY .................................... ........................_.DATE <br /> ....... .. ...........DATE....................................... <br /> BUILDING PERMIT ISSUED ..... ........ ................... ......•..•-.•.... ........................ ........... <br /> .......................... <br /> ADDITIONAL...C....O......M.....M-..I E....N......T..S.....................-............................................I..............I..............................................-............................................................................................................. <br /> ................... <br /> ......................-.......................P..................................................................... <br /> ...................... <br /> .......... <br /> ............. ........ 7 <br /> . . I .. ....... ........... ....... .. ..........I. .............. .......... .....Date . !.. . .................. .. <br /> FinalInspection by. ........................................... .... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev, 5M <br />