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FOVICIFFICE USE: a <br /> APPLICATION FOR SANITATION PERMIT <br /> . <br /> .................................. . Permit No, 7- <br /> (Co <br /> mplete in Triplicate) <br /> Date Issued <br /> ...........I.........11.......I................. r, This Permit Expires I Yeor.From Dot*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/LOCATION,.....p Z ...................... ................ .........CENSUS TRACT ...... ........... <br /> Owner's Name ---4 .....................................................................Phone ....................z............... <br /> s-- . ........................................... <br /> fp -........... ......­­ City �1:570*964 ... <br /> _eo, <br /> Aciclre�i --------- ...... .................... <br /> A'rfee...... ...... .......Aicense # <br /> Contractor's'Name ...... ire, ............... Phone ....... <br /> Installation will serve: �- Reild6h'cepq-,Aportment.Houseo,CommercialoTrailerCourt 0i <br /> Motel C]Other ..................... <br /> ..Garbage Grinder IVO.. Cot Size /.4746;... .................. <br /> Number of living units—Z-- --- Number of.bedrooms <br /> Water'Supply: Public System and name ------------ ...... ............................. --•--.:......:..--• ...............Private. <br /> Choroc'ter of soil to a depth"of 3 fee(. Sand 0 Silt[3 Clay 0 Pe'at-C] Sandy Loam C] Cloy Loam I— <br /> *Aardpon C:]',,—.Adobe.;K.-..Fill-MateriaI............. If yes,type ------------I............... <br /> (plot,p�Ian,: showing size of lot, l6cciticn of. system; in relation to wells, buildings, etc, must be placed on 'reverse..side.) <br /> NEW INSTALLATION: (No septicorseepage pit it permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I -SEPTIC-TANK-1. Size------------------------------I..... ------­.... Liquid Depth .......... .............. <br /> ---------------- ... No. : Compartments ............. <br /> Capacity ------ -!7 .... --- Type...................... Material <br /> ti INA Distance to nearest: Well �------------------­�...............Foundation ................ Prop. Line ....._:..____;-------• <br /> Z�, <br /> LEACHING-LINE` No. of, Lines. .........z.............. Length of each line------------------------------ Total Length ............................. <br /> -,.'D' Box ------------ Type Filter-Material ............:.Depth Filter Material ---------- ............. ........ <br /> ­15istance to nearest: Well .........:......•_-..... P43 <br /> Property Line .......... ... <br /> ---------- ... Foundation ----- ..... rty <br /> SEEPAGE PIT ....... <br /> Depth ------- ............. Diameter .............•... Number -------------- .... Rock Filled Yes, No; <br /> Water Table Depth .................................................Rock Size .......;........................ <br /> Disiafice'to neatest.• Well ------- ............................Foundation ....... .......... Prop. Line ....................... <br /> -AEPAII(JA6 DITION(Prev. Sanitation Permit .......................... ..... Date .................................. <br /> !Septic Tank (Spec:ify Requirements) ............. <br /> ......... .................. . ............................................ ",--1........ <br /> oo�l <br /> Pisoosal' Field (Specify Requirements) QA <br /> ,4, <br /> t ....................... ------- <br /> ----------------------------------- ............ --------------- .......... .......... .............. <br /> i-------------------- ------- ----------------------------------------------------------------------------_------------ ..................................... ........ ...... ....................... <br /> :!(Dfo'w existing and required. addition on reverse side) <br /> I hereby certify that I have prepareO,this application and that the work will be done'in accoiclance with�SaW Joaquin <br /> County Ordiftances, State Laws, and-Ruhis and Regulations of the Son Joaquin Local Health District. Honie owner or licewi <br /> sea agents signature certifies the foll'o'wing: <br /> '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 /> Signed ------------------------- ------ --•-•-•--.. ------------- Owner <br /> ---- - - <br /> ............. <br /> ..................... ------- ------------ Title ---------------------- <br /> By ......... _a. . I <br /> (If oche an owner) tj_ <br /> FOR DEPARTMENT USE ONLY <br /> E <br /> .. ........ ................ <br /> APPLICATION ACCEPTED 8 ........ DATE <br /> -Y ............ <br /> BUILDINGPERMIT ISSUED ------------- .. .............. ........... ........ ------------------------------------ ........DATE ................................................ <br /> ADDITIONALCOMMENTS .......... ...................s...........................I................................... ............................... ........ .............. <br /> .............................................. ........ ................................-1-------------------------- ................................. ........I.............. <br /> ............ ............. ........................................... ...... ............. .................... -•----•---------------- • <br /> ............................................ --------------- .. ...... <br /> Final Inspection by-.�_........ ............ .......Date <br /> ......................... --------------- ....... <br /> SAN <br /> . ................ <br /> 6AQUIN "LOCAL HEALTH DISTRICT <br /> r w 13 24 ,-•/,Q c,- qAA 7/7 <br />