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'FOR OFFIC15 USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................­............... ...I. Permit No. <br /> in Tripliratell., —1.1 P - , -I- <br /> .......---v.......--- ............................... gV3 <br /> ....................... ....................... --------- This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit" 'to i�6nstrLid'ancl: Install the wA herein <br /> described. This application is made in compliance wiP County Ordinance. No. 549 and existing Rules and Reguloitions-_ <br /> JOB ADDRESS/LOCATION04A ........................:..-.Phone...... ... ......:.........CENSUS 'TPACT'.... ........... .. <br /> Owner's No m'e Y PP..;7 ...... . . . .. ................. <br /> Address ....... .................... cit <br /> 'y Z.A.... 'L........... <br /> Contractor's Name ------ ........ ........ .................. ..........�;...... ...License # ..................... Phone ............... <br /> ............ <br /> Installation will serve-. Residence : rt <br /> 191 Apartment House 0 Com mer�ial OTraller Court ] <br /> Motel 0 Other ------- ............................A........ <br /> Lof Size <br /> Number of living units:--.--/---- Number of bedrooms ...I_.Garba'.ge Grinder............ /X ZZ 0... .......4 <br /> Water.Supply: PtiblicSystem'"and name ---------- .................................:...........................Privqte <br /> Character of soil to adepth of 3 feet, Sand Pact'[] Sandy Loam El Cloyloam' o <br /> 'Hardpan 0 Adobe 0 Fill Material ............If yes,type ...... C <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings,_,etc. :most be ploodd ch reyer4 side <br /> NEW INSTALLATION' : (No septic, tank or 3eepa pit permitted if pubkL sewer is 6vailable' -wilikin bOO"feetj <br /> 0 <br /> '1360th ...... <br /> PACKAGE TREATMENT SEPTIC TANK J� LiqV ......q. <br /> Capacity J.�.q.q..... Type .......,) <br /> Distarice.4o nearest. Well .......................Foundation <br /> P�_ rop.,Lide <br /> LEACHING LINE No. of Lines ....... <br /> "Tot4l Length <br /> Length opf each ........ <br /> j, <br /> V Box Type Filter Moteri �.e. e th fl lae 4, <br /> I' r w YY ,,.,,-y,,.... . .. <br /> 'Co <br /> Foundatio' ': Prbpeity <br /> Distance to-nearest: Well ........ <br /> _/_/_Pr,_1.......... N- <br /> ui�6i 71t6i:k Nlecl <br /> -I:-- - .. - :- - r <br /> `SEEPAGE-PI T Pe�th .... ......... Diameter .... ........................... Yes 0 ob <br /> X) <br /> Water Table Depth ........................*...........................Rock Size . r r r <br /> ........... <br /> Distance to nearest: Well ------ ......................FFoundationP <br /> --------- ... ---- - - <br /> REPAIR/ADDITION(Prev. Sanitation Permit 5# ............ Date <br /> ............... ---- <br /> "Septic Tank (Specify Requirements) ................... ........ .................................................... ........... ........... <br /> Disposal Field (Specify Requirements) --­--------- ........................................... .......................... <br /> ............. ..........:............. .............. ------­---------- ....... —...... ............. <br /> -------------- ----------- <br /> .......... <br /> ---•-----•--------- <br /> ----------------side--- <br /> I Draw__---,"---ex,_is__t_i,n_,g---and aired...addition....on reverse ) <br /> I hereby certify that I have prepared this application and that the work will be done In acco'iddhce;with Soi'.16aquln <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Hq*ItkDIstricbHom& owner 64111cen- <br /> sed-agents signature-certifies.the following: <br /> "I certify that in the performance of the work for whi&-thiC. person <br /> Isash manner <br /> ........ <br /> as to beep subu*eFt to Workman's C mpensation laws of California." <br /> Signe <br /> ---- ------- - --- ------------------��,_,Owner <br /> --------------­­­---------------------- Title ............ .......... <br /> --------------- <br /> ----- -------- <br /> (Ift. <br /> other t n ow ed <br /> Fg"EPARTM"T. SE ONLY <br /> APPLICATION ACCEPTED BY - --------- ....... ..... . ..... <br /> ---------DATE, <br /> BUILDING PERMIT ISSUED ---------------------------- .......................... --------------------DATE -- -------------_--------------- <br /> ADDITIONALCOMMENTS ------------------I............­-------------------I------ ---------1-1-... ............­---------- -------------------I------- <br /> I. -------------------------------- ­ ­-----­---------------- <br /> ---------- ... ....---*--- *----------------- <br /> .............. ------------------------------------------------------------ -/--------6-------------------------------------------------- ..............................I............. <br /> ...... ................................. . ..... --_----------_----------I...................... <br /> ----- -------- -------- <br /> ............ ..........................Date ... --- <br /> ---- -----­---------- . ...... <br /> Final Inspection by: __------ ......... 1:!5, <br /> EH 13 ,2h 1-68 Hev.t 5M SAN L�AQIJIN LOCAL EALTH DISTRICT 8/71; 3M <br />