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......... ....................... .................I....... APPLICATION FOR SANITATION PERMIT <br /> ............................... ................... (Complete In Triplicate) Perm It Na. .. ..... <br /> ............ <br /> .................. <br /> ------- This Permit Expires I Year From Date Issued <br /> Date Issued ................. <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/LOCM. ON.........51.1)�a� r <br /> 4� - -4 - CENSUS TRACT <br /> Owner's Name <br /> . ...........................Phone SM.R.Zz�F <br /> ----------- ................. ................. <br /> Address ............ <br /> ........................... <br /> Contractor's Name ....674�-AJZ ........ city ............ .............•---•------................. <br /> ...... ..--------..------•,.-•---•................................License # .-_......'....--•-----•. Phone <br /> Installation will serve: Res IdencerB40�dffim—e-nt­%Use O-Commerci I of C]Trailer Court 0 ... .................. ........ <br /> Motel 0 Other...... ...... <br /> 7-1 <br /> Number of living units Num6r of bedrooms ...:�_.Garbage-Gr-.... <br /> Inder ..... ........................... <br /> Water Supply. public System-and nam Y ........ Lot Size .... ............. <br /> e .............. .... . Z <br /> ............... <br /> Character ......................................A..........Private e-'I <br /> of soil to a depth of 3 feet: Sand 0 Slit 0 W� - ­_ <br /> " Peat❑0 lay <br /> Cl ". 0 Sandy &��C Loom 0 <br /> Hardpan 0 Adobe Fill M6t'erial ...... if yes,type ........ <br /> A- ..................... <br /> (Plot Plan, showing size of lot, location of system in relation to.Wells, buildings, etc. must be Placed on reverse sid <br /> NEW INSTALLATION:, lNo septic4ank-or-seep <br /> pit pbrmitted if public sewer is available within 200 feet) <br /> PACKAGE TREATMENT H SEPTIC TANK f7 - Size.. <br /> Liquid Depth .......................... <br /> ................ <br /> Capacity .2000 TYP,0--0(4' <br /> . ........11....... --- -----A........ Material.CO-%L .. N o. Compartments A................. <br /> Distance to neare' 6/ ,Y" <br /> n <br /> LFACHING,LINE nearest: Well '...',�2--------•--------`-77­Foun&tIon .../V.............. Prop. Line ...70.......... <br /> o. of Lines __q <br /> ...... Length of eacfi�line. ................ Total Length ...�?±-O............... <br /> 'D-Box-7-Af—.... <br /> TVPe-F�Iter-Materld&/Y2;-::q/1 <br /> t <br /> ......Depth Filter Material ......IV <br /> .............4.........;......... <br /> Distance to nearest. W611 <br /> Foundation ....152,.e........... Property Line <br /> SEEPAGE PIT • Depth ................... <br /> .....•......11............... Rock Filled Yes rj No 0 <br /> Water Table Depth ........... ................. 10� <br /> ........ .....Rock Size <br /> Distance to neo�rp-sti-W611 ....... I i .............................. <br /> .............. .. ..........Foundation <br /> ......I......... Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .... <br /> .................. ------------------- Date.:......... <br /> Septic Tank (Specify Requirements) ................... <br /> Disposal Field (Specify Requirements) ......................................... ............................ ........................................ <br /> --------------------­--*.......*....... .................... .................... <br /> --­--------------- ------­­.............. ------- ........................................................................ <br /> .............11-------------­- ------ <br /> ......................•--•--••--...--••---......--_...... - <br /> ................... ......................... <br /> -••----•--•--•--,--_---•--•----...•----••--•-•••-• ...........................................I...... .............. <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 done in accordance with Son-Joa4u in <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. <br /> sed.agents signature certifies the following: <br /> certify I that h inhep ormance of the wotk'for which this permit Is Issued, I not employ any person In such manner <br /> as to bec s <br /> om ec W k can's mpensation laws of California.- <br /> Signed <br /> By ...... . .............. ..................... Owner <br /> ................. <br /> .......... <br /> . .......... <br /> (If other than owner....... ------- -------------- .___--__.__.--.--_•-• Title ......... ................ ...... ............... <br /> FOR DEPARTMENT USE pNLY <br /> APPLICATION ACCEPTED By <br /> BUILDING PERMIT ISSUED ................ --------`---------11.......................... DATE .... <br /> _7 <br /> -------------------------- , __? ....... <br /> ADDITIONAL COMMENTS ................... .............I--......•-----•...._.,_.............DATE <br /> ----------------- ------- ....................... ....... ..... <br /> - --------I..... ........................... ...........I....... ....................................................... <br /> ................. ... ........I I......... ..................... ............. .........I......... ............."........... ........... ....... <br /> ..................................................... ......... .................m......... ...... <br /> .............. .................................................... .......... <br /> i� :J�............. ...... <br /> .. .. .......... . .......................... ......................................... ................. <br /> final Inspection by:....... . <br /> ....................................... ..... .. .............. <br /> C <br /> .................-----..........Date <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br />