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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ...................... Permit,No. <br /> ............................... (Complete tin TrIplicafoll . � .., I ,. <br /> ........... ................................... Date Issued <br /> This Permit Expires I Your From Out*Issued <br /> .................... ......1 . <br /> Application is-hereby mode 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 Na. 549 and existing Rules and Regulations- <br /> JOB ADDRESS/LOCATION r.-7.7.-,,If-..A�,..-,Tt?al,�l;?C ............... ...................:r...CENSUS TRACT .......................... <br /> Owner's Name Z 1�� ...Phone ................................. <br /> ...... ....... <br /> city -Z 0 7 <br /> ss ........Sa ....eto <br /> ---- <br /> Address -,00-w. ..... ....................... ...................... .............. ......... ...... <br /> ......................License <br /> Contractor's Name .......... phone <br /> Installation will serve: Residence Apartment House{] Commercial oTraller Coutt-_0 <br /> Motet 0 Pthe�r............................................ <br /> Number of living units:_-4.... Number of bedrooms ...%?_--Garbage Grinder -—------ Lot Size -6iue- -fir.................. <br /> Water Supply: Public System and name ..........I.....................................__............... .......................Private R) <br /> Character of soil to adepth of 3 feet: Sando Silt cloyo Peato Sandy LoaCn:-El Clay Loam jO <br /> Haidii an g] Adobe 0 Fill M6terial ............1f 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 public sewer is available within 200 feetJ <br /> Liquid D <br /> PACKAGE TREATMENT SEPTIC TANK{ I Size............�T-------�:----------------*........ opth ..................... <br /> Capacity ...... .......I—— Type................. J.............. No. Compartments ..................... <br /> Distance to nearest: Welly Foundation . ..... Prop. Line ..........i........%__ <br /> .. ........ 0 <br /> LEACHING LINE No. of Lines .......... Length of each line----------------- ...... Total Length ............................. <br /> V Box ........ ... Type filter Material ........I.............Depth Filter Material ....--..••--•--•..........I.................. <br /> Distance to nearest: Well- -, --�---------------- Foundation ...................... -. property Line .................... <br /> SEEPAGE PIT C j Depth ........ ...... Diameter ......... Number ............................ Rock Filled Yes [3 No 0 <br /> WaterTable Depth ------------------------------------- ..........Rock Size ............ ................... <br /> Distance to nearest: Well ....r..........................:........Foundation ..................... Prop. Line .................. <br /> REPAIR/ADDITIONIPrev. Sanitation Permit# -•-•.---•••-----•--••-•.... ........ ....... Date _--------------------------- <br /> -------............ <br /> Septic Tank (Specify Requirements) ..............• .... ............. .......... .............. ­01 <br /> ........ .... <br /> . ............... ........ ....... <br /> Disposal Field (Specify Requirementsl A <br /> ------------ ..................... ...................... .................... ....... .................... <br /> .................... --------I..................­........1­ ....................­........11...............I..................... <br /> -------- ---- -- ­ ­ <br /> -------I------------------­­------------- ........ Draw existing and required addition on reverse sidel <br /> I hereby certify that I have prepared this-application-and that the work wilt'be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,,District. Homo 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 4hall not employ any Person In such manner <br /> I as to become subject to Workman's Compensation laws of California." <br /> I Signed ---------------_----- ------ ------------- - <br /> -----_--_---- Owner <br /> 0 <br /> "o........................I--------- Yitle . ...... <br /> . .. ................................ <br /> BY -------------------•-- <br /> 0 <br /> (If of ha n o Wnerl <br /> ffO& DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ -------- --------------------------------------------- -------- ......... DATEC----------------- <br /> ...........................DATE ........... .............. ................ <br /> BUILDING PERMIT ISSUED -------------------- -- --- -- ------ <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------- ---------------------------------- <br /> ----------- ---------•----------------------------...._._.._I------------...------ ---......_......-_.•'.................----•---- --­----- <br /> •------- <br /> ----------------I­--------------­ <br /> ................ .............—------­-------------- __", "" <br /> ....­­------- ---------------- --­-------- ....... <br /> --- -------- -----­----- <br /> - 'L _ A � ------------------------- .. . ........ ............ <br /> --------­-------- ....................­-------------­- ------------­- " !7 <br /> -------------- ---- ------- . ......e___............. <br /> i Final lnspectibn-Vyi� -------------- --------------------­1­1--------- ................... <br /> EH 13 2L 1-68 Rev. 5M S N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />