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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> ...........................................................74......m-......... (.Com plete1.n.TrIplicatel— Permit <br /> . N,o. 7(�—. /j <br /> . <br /> �S7 <br /> .................. . ........ ...... ............ This Expires I Year from Date Issued Doto Issued . . -. y <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application Is mode In compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATI ..�-6.8!!� 7../VAW;-SS."....IA/A/ ..........CENSUS TRACT —....... ............... <br /> ................. �0 , 'r r ..............I......... .........Phone ..�g7 <br /> Owner's Name .. ..... ..............Zy;= <br /> 2-_-l-------------------- <br /> Address 59�l---/W�4�4--- .....................I——........ City <br /> e_o A-1 <br /> ........................... <br /> Contractor's Name --------- Phone <br /> ........__-----------_----------------6oln' ... ---------License #2SY <br /> t - .............. .... <br /> Installation will ieivdl:�' - ' <br /> Residence 01(partment Houseo Commercial OT- raller Court C) <br /> Motel E]Other ---------- ................................. <br /> Number of living itsi 6 X2�, zzelgls <br /> un -------/--- Number of bedrooms ---;�n....Garbage Grinder ------------ Lot Size ............................................ <br /> Water Supply. Publit'Systi6m and name .............................. ------------- <br /> . ......... ...........:.........................................Private <br /> Character of soil to a deAh of 3 feet: Sand L3 Silt F] Clay 0 Peat 0 Sandy Loom fia"'Cloy Loom [] i <br /> Hardpan Adobe f-] Fill Material ........ If yes,type. .1 <br /> .................. <br /> "(Plot-plan, showing size of lot, location of. syst6m in relation to wells, buildings, etc, must be plated on reverse side.)K <br /> NEW. INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ) SEPTIC TANK I Size./ Depth .............. <br /> Capacity - ----- --:P-ITY pe --------------- .... Material_. .............. No. Compartments ...................... <br /> Distance to nearest. Well ................................Foundation ----------------------- Prop. Line ..._r............... <br /> LEACHING LINE No. of Lines ----_------------------ Length of each line------ -----------------_- Total Length --------------_------_-_ <br /> V Box ......._.. Type Filter Material .._..._._Depth Filter Material ---_._................................... <br /> Distance to nearest: Well -----------_---------- Foundation ........................ Property Line ................;....... <br /> SEEPAGE PIT Depth ......... .......... Diameter ---------------- Number ...--------1............... Rock Filled Yes No (3 <br /> WaterTable Depth ................................................Rock Size ................................ <br /> "­ � . <br /> 154stance to nearest. Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...........................--------•-------- Date -------------------•--------••-- -1 <br /> Septic Tank'(ip�ecify Requirements) .....----------------------------•------------- <br /> -.-.--.-.-.-.-.-.-.-.-.-....................................................................... <br /> Disposal Field (Specify Requirements) o I'­e ................................ ---- <br /> ------­--------------- ------- ---------------------------- ----------------------------------------------------------------------------__-------11---1................ <br /> (Draw existing and required addition on reverse side) <br /> f —1-hereby-certify that I have prepared-this application-and�that the work will be done, In- accordance-with,with,Son-460quln <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local,Health District. Home owner or ficen- <br /> sod age"nis signature certiflei the following: <br /> "I 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 becom ec o or a ompensation laws of California." <br /> r-ffi_� c W <br /> Signed ----- ---------- ------ ------ --------------- <br /> =Z -- --------- .......... ------- -------- Owner <br /> BY.. ...................................oe - <br /> -- ------------ ------ ----­--------------------- ------- Title ----------- ........................................................ <br /> (If other than owner) <br /> FOR DEMRTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- -—---------_ --------- .......DATE ............... <br /> BUILDINGPERMIT ISSUED ----------------------------- ---------------------------------------------------------------------....--.DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----- --------------- -------:------------------------­---- ------------------------------------------............... <br /> ,7;---------- ---------I------ ------------------ Z,_/1------ <br /> ;!F-, --------------------------------------------*----------------------`*-----------*---------------------------- <br /> -------------------------- --- -------------- -------­--- <br /> ----------------------------- -----­-­-_--1. ........ ....... ...... <br /> ............... ------------------------------ --------------------------------------------------- --------------- <br /> ............. <br /> Final Inspection by: ..............i ........:.........._.....-----------•----.._....Date . .......... <br /> Etf 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />