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____77i6R_0FFfCE USE: APPLICATION FOR SANITATION PERMIT <br /> -7 <br /> .................-------••---•-•...............I.-------- Permit No. .................. <br /> (Complete In Triplicate) <br /> ----­-----------­-------- ........... -7 7 <br /> t Date Issued ...... <br /> This Permit Expires I Year From Date Issued <br /> ----------- <br /> Application is hereby .made to the Son Joaquin Local Health District for a per'mit 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 /> 0 <br /> SUS TRACT .......................... <br /> W . ...............CEN <br /> JOB ADDRESS/LOCATIjQI`t..rj­- - -­­- ........ <br /> Owner's Name ..... .................. ...................................Phone --- ............................... <br /> Z_ <br /> CO ........................................................................... <br /> Address .................... ............ ..... .�/ city . <br /> ............ <br /> Contractor's Name .....5` ,C _..-•--•-I--------- .............................. ...............License # ........---•-•--........ Phone ............................... <br /> Installation will serve: Residence 2<P_a__rtment House 0 Commercial oTraller Court 0 <br /> 1 <br /> Motel0 Other------------------------------•-•--•---•.• <br /> Number of living units....J./.... Number of bedrooms .".J� .....Garbage Grinder ............. Lot size ..........§. .........7­ <br /> Water Supply: Public System and name ............... .........................................................._...................................Private <br /> Character of soil too depth of 3 feet: Sand Silt[-) Clayo PeatO. Sandy Loam o : Clay Loam ' <br /> 6 <br /> Hardpan 0 Adobe:[:] Fill M6teriol ............ If yes,type ............................. <br /> (Plot plan, showing size of lot;location of system In relation to wells, buildings, etc. must be pla6cl on reverse side.) <br /> NEW INSTALLATION: . (No.sbptic tank-or, seepage pit permitted if public sewer is available within 200 feet] <br /> Size-.-•---•---•--•-:-••....... Liquid Depth ........; ................ <br /> PACKAGE TREATMENT I'-.] \�SEPTIC'TANK I ...... ............. th 4�k <br /> eqpaQ_t�:5_W;��....... Type6r.41E46--- No. Compartments .... ............ E <br /> Distance to nearest; Well ....le-20-.1 ....................Fou'ridation _A0............ Prop. Line <br /> LEACHING LINE Lines- ....!-Length of each line........IM..`............ Total Length ....... <br /> ox; ........................... <br /> Type Filter Material. Xi�-� Depth Filter Material ........./.f.." <br /> I. f �ftj.- .,�... <br /> 10. ..... do <br /> Distance to nearest: Well j_L .. ... . Foundation ...h................. Property Line <br /> SEEPAGEPIT _157........ Number --- Rock Filled Yes <br /> 77------------ 04 <br /> Water Table Depth ............ :L7---Rock Size <br /> ................................ <br /> I I *..j.... i . I � 37 <br /> Taept <br /> Distance to nearest- Well'7�n_% $A.......................Foundation .................... Prop. Line ...... ......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit ............ Date ...........................:....A <br /> Septic Tank (Specify Requirements) ...... .........................................................................I.......­........­........... <br /> Disposal Field (Specify, Requirements) .....i...........................::....... ......................................4...........­................................ <br /> -------------------I......... ..........7---•------------ .................------ <br /> .. ............... <br /> .......................•-------•--------- .°_....._....-•. -------................­.............. .................... ....................................... .................. ...... <br /> (Draw-e—R—Isting 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 San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District.-Home owner or liven- <br /> sed agents signature certifies the following: <br /> I certify that in the perf6imance of the work for which this permit is issued, I shall not employ any person In such manner <br /> s to become-jupiect to WorkmVq 'sC4*mpensation laws of California." <br /> ;I Ail <br /> Signed --------- <br /> ------------------------------------ .................................. Owner <br /> By ----- -------- -------- -------------------------------- ------------------------------------------ Title ............................... ................................ ........ <br /> (if other than owner) <br /> A-9 OFt,?DjrPARTMENT USE ONLY <br /> .............DATE ......??........ <br /> APPLICATION_ACC-EPTED,B-Y-,:�... .......... ........ <br /> BUILDING PERMIT ISSUED ............... ...... ........................._,_............... .DATE ....... ............._............. <br /> ADDITIONAL COMMENTS ................... .......I.— - __> ........................................... <br /> ............................................................................. <br /> ............................................................ ............. ................ ....... ......1­................ ............ ............................ .......... I......... <br /> ---------------------------------------------------- ......................5..------...._.._....1 14 A <br /> .........................I........................................................ <br /> .......................................... <br /> --------------- ------------- ---------------------------------------- <br /> FinalInspection by.. ...... ......­................I......... .......... .................Date .... .................... .......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Etat_13241t--A�micL_ r_" <br />