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FOP, OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> 051/ <br /> .............................;................... Permit No_).E..�........ <br /> ii, (Complefe in Triplicate) i <br /> ..................................... ....... <br /> .............I.................. ..... i 7S <br /> ..... . this Permit Expires I Year From Dat*Issued Date Issued <br /> ?6o <br /> Application is hereby made to the Son Joaquin Local Health District for a permit <br /> mit " 'Iconstrt;ct and Install the work herein <br /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> .. .... . . <br /> JOB ADDRESSAOCATIO O.A'. .7 .....CENSUS TRACT .......................... <br /> / , - I F a....... <br /> ec I- <br /> Owner's Name ............ .. Bt�----- ------- •••.___------•---------_____...___,----••-------..:..... ..........Phone5o..—.03.0......... <br /> . .. .... ........................... .........city .... .. ................... ........................... <br /> Address ­5 <br /> --------------- 7 2 <br /> Contractor's Name ---------------- --•--------- ---- ..............License .... Phone AL. 407 <br /> Installation will serve- Residence p Apartment House orn I I OTraller Court 0 <br /> Motel []Other . ... ..... <br /> Number of living units:-j-..... Numbe'r-of bedrooms.-_.9'._._Garbc!ge qrirdr ............ Lot Size .... .......... <br /> Water Supply. Public System and name .. ........ ... J.it".................—-------.............. .....................Private <br /> . . <br /> Character of soil to a depth of 3 feet. Sand O, Silt o Cla'Y.,[j -7 Peat 0, Sandy.Lo6m A " -0 Clay Loam 's <br /> I �IV <br /> �- <br /> Hardpan oiie .111 Mtdierioli��.........if ye!�,4�.p ...... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must b,placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet;) <br /> PACKAGE TREATMENT I ) SEPTIC TANK Size._.......:T-X-k........................... Liquid Depth ................ <br /> c 1 N o. Cotivartments . .............. <br /> Capacity .... Type ... . Material <br /> Distance. to nearest: Well ....... .........Foundation _./A��S ­­ -Piop. Une .s ................ <br /> ........... r <br /> LEACHING LINE No..:of Lines ------A��... Length of edifi'line--- -Total-Length ................ C) <br /> V Box Type filter Material .610-rA-...�-Depth filter Material .......l8.`:.................___......•. <br /> Distance to nearest•. Well ...... joundation ------- ... Property Line ..S.. .......... <br /> SEEPAGE PIT Depth ......... Diameter ..V.1'i1i.,*Nunnber ................. ...... Rock Filled Yes j No <br /> ---------................................RockWater Table Depth <br /> Size D <br /> r t <br /> Distance to nearest: Well ....... ................Fo14kvunclatjon--).6_7t`..... Prop. Line .......... <br /> REPAIR/AbDITION(Prev. Sanitation Permit# ..... --_-_------------_-- ....... Date .____•--.--..._..._..___-..__..._..} <br /> '• <br /> Septic Tank (Specify Requirements) ------------------------------ ----•••----•----------•--.._...._._._.._......_.......------ --------....._.I..--..... <br /> .............. <br /> Disposal Field (Specify Requirements) ----- --------- .......... ........................... ........................ ---------- ----------•-•...__.:-__._---........ <br /> .............�:j r. ...................I........I....... <br /> ----------------------------------- ---------- ------------ ------------------•------ ---------- <br /> — <br /> ....................I.............................. <br /> ----------------------------------------------------------M�------------------------------------------------...... ..... ........ <br /> (Draw existing 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,Ordinonce$, L <br /> Nome Si;t ws and Rules and Regulations of the San Joaquin Local Health,District. H me owner or Dean- <br /> sed agents sign6ture Cert4l; s the following: <br /> I <br /> "I certify that In the performance of the work for which this permit is Issued, I *hall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------ <br /> ................ ...................... Owner A_ <br /> By4 - <br /> ---------------------- ...... .... T_.... Title ---------Ca .......................................... <br /> --- ------- --- --Uc <br /> Of other n owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BYt-------- .-_-------------•-------=------­------­­------------------------------- --------- DATE •-- ----- _----------------------- <br /> BUILDING PERMIT ISSUED .......... -----------I..........I----DATE ------- ................................... <br /> ---------- ------ .................... <br /> ADDITIONAL COMMENTS ---!4Z:4 -------------------­--------- .......... ..................... <br /> ---------------------- ..... 'L.A-----------_-, , " <br /> ----------- ---- --­-----------------: -------------- -------------------------------------------------------------- <br /> -, 1 <br /> . j_&>4 <br /> ................................ ------------------------.....I <br /> .............................'.....:_....--•---•-­•------ -------•-••-•---- ----•------- ..............­ ................ <br /> ---------------- ...... ------------- ....... <br /> final Inspection by- -------------_- ................ ............................. ....................... <br /> ---------------------- ---------- ------------------ <br /> .......0 . <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN -LOCAL HEALTH DISTRICT 8/74 3M <br />