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:AOR OFFICE USE: PEI, T <br /> _PPLICATION FOR SANITATION 11w, Permit No. ... ....... <br /> ••.......................... (Complete in Triplicate) <br /> Date Issued .................... <br /> This Permit Expires 11,Yebr,from Dote Issued <br />........................••---...............••--. .. I I --_ I ., <br /> I r permit to construct and install the work herein <br /> made to the Son Joaquin t�661 Health Dist ict for a I <br /> Application is hereby h C 549 and existing Rules and Regulations: <br /> described. This application is made-in compliance with �quntY Ordinance No. <br /> ....CENSUS TRACT ........ <br /> JOB ADDRESS/LOCATION 0' 0.5?! <br /> riON Phog-e .................................. <br /> ............... <br /> Owner's Name .............. . .......11............ <br /> Address <br /> Cit <br /> ------_-----) -19 <br /> Contractor's Name . .....................License # 9.1 Phone _635-C), <br /> ercial PaTraller Court 0 <br /> Installation will serve: ResmidencetApar 6ntHouseOComm <br /> Motel 0 Other --------------------------------- <br /> - Lot Si�ze .._..__..------•-•----••••........ ........ <br /> Number of living units_____________ Number of bedrooms ............Garbage Grinder ... -------- <br /> Private 0 <br /> Water Supply: Public System and 'name ----------------•-----•-•----S [] Clay 0 ' Peot C3 �cindy Loam 0 Clay Loam 0 <br /> Character of soil to a depth of 3 feet. Sand 0 ilt <br /> Hard-pan ❑ Adobe X Fill Materia! ............ If yes,type .�------ ......... ------- -- <br /> (Plot pion, showing size of lot, location of. system in relation, to.wells, buildings,-etc,-friust be placed on reverse tide.) <br /> NEW INSTALLATION: iNo septic'tonk or seepage pit permitted if public sewer is available within 200 feet) <br /> Liquid Depth ...... <br /> SEPTIC TANK{ ......... <br /> PACKAGE TREATMENT . .... <br /> ts <br /> Material Na. Comportmen 0 <br /> Capacity ...... Type <br /> Ge.--- ...Foundation ....... Prop. Line ...C34) 1••....0 <br /> -i/_jL <br /> Distance tb nearest: Well ..... _,o <br /> 49 <br /> ...... Total Length ------- .................... <br /> LEACHING LINE N6.-bf Lines _.---------- Length •of each line------------__:­ <br /> -I ......._Depth Filter Material -------------------------------------I--- -Z <br /> V Box ------------ Type Filter Material ----------- ........................ Property Line ..............•......... <br /> Distance to nearest: Well ...................... Foundation Rock Filled Yes Cl— -NO 0 <br /> Diameter ................ Number <br /> SEEPAGE PIT Depth ..... ........... i <br /> WaterTable Depth .......... ............-------- ................Rock Stine---------------------------------- <br /> Ifoundation ... ........... .... Prop. Line ............. ........ <br /> Distance to nearest: Well __-•-----------------------•------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permitf -_.__....---• ............. ........ Dote _C <br /> i ...... <br /> Septic Tank (Specify Requirements) <br /> Disposal Field. (Specify %equirements) ... ........ -- ---- ....... ............... <br /> ___---------•--------• ------­...... ...... --••-...--------••-------•- <br /> ----------- ----------------••----------------- ----------------- --------------------- ---- <br /> -- -----------------*------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this app once with Son Joaquin <br /> application and that the work will be done in accord or or lican- <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health DistrIct. Home own <br /> i sod agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is Issued, I shall not ornphoy any person in such marknew <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ... . ......0...... ... ... ...........­..... Owner <br /> . ;Ce!�i • <br /> ...... - - - ---- ---- ....... -- ------------•--------------- <br /> B <br /> .----------_--------------_ <br /> ...................... Title <br /> B y, <br /> (if other than ner) <br /> FOR DEPARTMENT USE ONLY <br /> --­----­-------- <br /> APPLICATION ACCEPTED a . ............................... .... .............................. DATE <br /> .........DATE .................................... ------ <br /> .............. <br /> BUILDING PERMIT ISSUED ......... '11-ee xnte...... <br /> ------- ----- <br /> ADDITIONAL COMMENTS <br /> .......... ....... <br /> ................... ....... ................ ...... . ........ <br /> ...... ........... ....... •. <br /> .. .... . .... ......... -------Date lel.9�...................... <br /> --------------- <br /> Final Inspection .. . . . .. . . ..... ...... ...... <br /> SAN..JOAQUIN -LOCAL' HEALTH DISTRICT. <br /> 02 3 Xh- <br /> Ilk <br />