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FOR OFFICE USE: APPLICATION FOR SAWTATiON PERMIT Permit No. 73 /US <br /> .................................... <br />......... (Complete in Triplicate) <br /> Dote Issued <br /> This Permit EjZp1res 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 herein <br /> described. This application is made in compliance with County Ordinance No, 549 and existing Rules a:nd Regulations- <br /> JOB ADDRESS/LOCAT16N .................... ....4_1..... ................-CENSUS TRACT <br /> Phone,..��W____............ <br /> ..... ................ <br /> Owner's Nome ........... . . . . . ......... <br /> .. ..---• ......... City ....... .......... <br /> Address ........................ <br /> -license ... Phone <br /> Contractor's Nome ...... ...... ..... . .................................. .. <br /> 1; � , Residence iol:[3Traller Court 0 <br /> installation will serve: Wportment House 0 Commercial <br /> I Motel 0 Other .... -......-•--....-•---•--•---......_ <br /> Lot Size y ........... <br /> Number of living units .......6. Number of bedrooms .�.;.....Garbcige•Grinder ...... Privatex <br /> ...... ...... <br /> Woter'Su pply.-Pub I ic­Systerr�-b nd,no me;��...�­.......... at Sandy Loom ❑0 Clay Loom <br /> Character of soil to a depth of 3 feett Sand 0 .Silt 0 Clay ❑ Pe0 <br /> Hardpan ❑ Adobax, Fill Material ........ If Yes,type -_:•-------------- <br /> 16� ildings, etc.-must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of. system in relation to wells, u <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if-public sewer-ii available within 200. feet,? <br /> Size................................................ Liquid Depth .......................... <br /> PACKAGE TREATMENT SEPTIC TANK I Material...................... No. Compartments ....................... . Jo <br /> Capacity .................... Type _.............. oundation ..---•--......._...... Prop. Line ...................... <br /> Distance to nearest- Well ...............••••.................F <br /> LEACHING LINE C No. of Lines ................. ...... Length of each line.......... !%-.,.......... Total Lengih <br /> Depth Filter Material ............................................ <br /> V Box ............ Type Filter Material _................. <br /> Distance to nearest. Well .............. ......... Foundation ........................ Property Line ........................ <br /> ......... Rock Filled Yes (2 No 0 <br /> SEEPAGE PIT Depth .....­­...... Diameter .......... Number ................... <br /> .............Rock Size.,................................. <br /> Water Table Depth ............I..................I-—..... <br /> a.nearest: Well ............................... ........Foundcition--�................... Prop. Line ................ <br /> Distancet ........I-- ..............�;........... ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit 46k ........................ <br /> - Date.�­..... . ................... 7............ <br /> Septic Tank (Specify Requirements) ........................ ................... <br /> ---------- ................ ............ <br /> .... ...... ... .. ---- ---- <br /> Disposal Field (Specify Requirements) ....9 ....... .... <br /> -t...... ..... <br /> ...uk <br /> ................. ..................... <br /> ........................ ...... ......I—............. ........ <br /> ........ ....­ <br /> - -----------------------------------------------------------{Drawexistingand required addition on reverse side) <br /> A that the work will 'be done in accordance with Son Joaquin <br /> I hereby certify that I have prepared this application an <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Nome owner or licen- <br /> sed agents signature certifies the following. <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> ---­­.... ............... ... ... •......................................:n. owner <br /> Signed <br /> 441 • Title .................... .............................. <br /> ......................... <br /> By ........... <br /> (1i othe t an owner) <br /> L E <br /> ONLY <br /> JF4�Ir ........- <br /> FOR DEPARTMENT USE ONLY <br /> T <br /> D .. <br /> DATE .... <br /> E <br /> D ...... ......... <br /> . . ................ <br /> ... .... ..... <br /> ...... .... ..... ......... .......... <br /> APPLICATION ACCEPTED. BY .. . .. :..........­................_ ......DATE ........................................... <br /> BUILDING PERMIT ISSUED .......................................................................... .............. <br /> . ... ...........:........I............ <br /> ADDITIONAL COMMENTS .............. .. ........ ....... <br /> ......................... <br /> ....I..... --? ........................................ ...... <br /> ........................... <br /> ..........I—...... ......... <br /> .......... ... .............. ...... <br /> .................................... ................. ........... <br /> ............... ........ <br /> ........... <br /> ........... .... <br /> ...Date <br /> .... .... <br /> ...................... ............ ...... .............. <br /> Final Inspection by. ........ <br /> HEALTH DIICTVk 1,21" <br /> SAN JOAQUIN -LOCAL <br /> 7/723M <br /> r t_1 13 24 1--mi Paw- SM <br />