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OFFICE USE, <br /> ..............•-•-............_. <br /> "APPLICATION FOR SANITATION PERMIT <br /> p ­ -3 <br /> tComplote in Trilicate) Permit No. <br /> ......................................- <br /> Date Issued <br /> ............................................... this Permit Expires I Year From Date 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 ..................... ......CENSUS TRAa .................... <br /> Owner's Name ....... ......-........... .. ................... .............-Phone ... <br /> Addres's. .............P. .............................. ....... ............... ........ <br /> Contractor's Name ..........................z........License # Phone <br /> Installation will serve- Residence QWApartment House f] Comm erciaI_oTrci ller Court-0 <br /> Motel0 Other ...... ........... .................. <br /> Number of living units:../....... Number of bedrooms ...a...Garbage Grinder ............ Lot Size .... 1 At= .......... <br /> Water Supply. Public System and name ...................................................... ....................................................�.Private <br /> Character of soil to :0 depth of 3 feet. Sand 0 . Sil�t_ Peat,[), Sandy Loom 0 Clay Loom [] <br /> Hardpan 0 Adobe Fill Material ............ If yes, type ..................... <br /> (Plot pion, showing size of lot, location of. systervi-.In_-relotio'n 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 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK T Size....' Y_ ............... Liquid Depth ................ ..... ... <br /> Capacity Typw-,,PAfc:196r Material._. .......­­ No. Comportmerits -?.......... <br /> Distance to nearest: Line IY ....... <br /> Well .......................Foundation ----------... Prop.' '. <br /> LEACHING LINE No. of Lines ... ....... Length of each line.__. ............. Total Length ........ <br /> Type-FilMateria aterl <br /> "It-D' B"Px4" .Depth Filer'.I�Laterla I_a2f....:.......I------._..------ <br /> • Distance to nearest: Well .......... F6undation ../0--- Property Line/.L0 <br /> SEEPAGE PIT Depth ............ ........ Diameter ................ Number ..................... ....... Rock filled Yes 0 No ❑ <br /> Water Table Depth ....................... .......................Rock Size ................................ <br /> Distance:to nearest. Well ........................................Foundation .................... Prop. Line ............. ......... <br /> REPAIR/ADDITION(Prev. Sonitotton'Permit# ................................. ...... Date ..................................I <br /> Septic Tank (Specify Requirements) ...... ...........1..........1......... ................................. ............ ......................... <br /> L ------------- <br /> Disposal Field (Specify Requirements).. .......... ..... ............ ...... ............ -----------------------*............--------------------------------- <br /> .*...... <br /> ................ ........ ........................ ------- <br /> ......................................... .............................................. --------- <br /> s. <br /> ----­-------------­­------------­----------- ----------I.......................�J................._........ ................... ................................................ <br /> ' (Draw existing-pncl req 4red addition on reverse <br /> I hereby certify that I have prepared this application and- that',th6'wk will 6 d6ne in accordance with Son Joaquin <br /> County Ordinances,'State Laws,`and , L afj the" i an 1,or; <br /> �ancl Rules ancl,RepulatiA's Joaquin Local Health District. Ham& owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance-of the work for-which-4hisproimit-is-'Iisvod, 1-shall not employ any person in such manner <br /> tion laws of California." <br /> as to become subject te, kman s��ens iforni' <br /> Signed .... ...... ....... Owner <br /> 7 ------------------------------- <br /> By .... <br /> .................................. <br /> ........... ........... ................. .......... Yitle ...... ....................... ............... .............. <br /> (If other than owner) <br /> FOR DEPARTMEW USE ONLY <br /> :i:,2 <br /> APPLICATION ACCEPTED BY .................................*­­- ...... D <br /> BUILDING PERMIT ISSUED ................. ................... <br /> ...... ...... .......... ..Z.-----• <br /> . 7 .::.r.: :. .:..................DATE ....................... ................... <br /> ADDITIONAL COMMENTS .......................................... .. ....... I .. <br /> I ,=7 ........... .................... <br /> .........................................................I.......":---...........................------........................................... .......... ............----------- <br /> ••--......•....••------•---•---•---• ................................... ........................ <br /> ............................... .............. .......... ............................................................... ...... <br /> ....•--••...... <br /> .......... _........--•------. <br /> ...........------- <br /> Final Inspection by <br /> .................................t.11............................ ........Date ... .................. <br /> SAN <br /> . ....... .......... ........ <br /> JOAQUIN LOCAL. HEALTH DISTRI <br /> 9!,E. H.13 241-'68 Rev.5M, 7172 3 <br /> M <br />