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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .............. ---------- ....................... <br /> (Complete in Triplicate) Permit No. ....7 <br /> ................. <br /> . ... <br /> --------------------- .............. ...... This Permit Expires I Year From Date Issued 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 CoUnWOrdiRbrice No. 549 and existing <br /> sting Rules and Regulations: <br /> JOB ADDRESS/LOCATION e......�/;�,,,/!_, e <br /> �Wo .CENSUS TRACT .......................... <br /> Owner's Name /01401*10.6..4/ ........... ...............................Phone .................................... <br /> Addresse--..-------- ....---.-........ ................... ------------------------ City"+- zooe,_17. ........ ........................... <br /> .Z7 <br /> . I <br /> Contractor's Name 7—p_ '49ev ........._ .............................License # 19&.". f. Phone .a/lo...... <br /> Installation will serve: Residence 2f Apartment..House C] Commercial E]Trailer Court 0 <br /> Motel E] Other ............... <br /> Number of living units:..../.... Number of bedrooms Grinder ZVf_ Lot Size 1a_d4-!W_747............. <br /> Water Supply: Public System and name .................... ...............................................................................Private <br /> Character of soil to a depth of 3 feet: Sand E] Silt[—] Clay 0 Peot 0 Sandy Loam IN Clay Loam 0 <br /> Hardpan ❑ Adobe ❑ Fill Material ....... .... If yes, type -----------------_-----_ <br /> (Plot plan, showing size of lot, location of system in relation 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 f I i•SEPTIC TANK Size.----....................... .... ......... .... Liquid Depth .......................... <br /> Capacity. .. ................. Type ------------------_ Material..---_ ..... . V <br /> No. Compartments ...................... <br /> Distance."to nearest: Well .........................Foundation .......... Prop. Line -------------_------- <br /> LEACHING LINE No. of Lines . .... ..... Length of each line............................ Total Length ...._...................... 'E <br /> %, 01A, F <br /> 'D' Box ...... .... Type Filter Material _-------------------Depth Filter Material ............. ................. <br /> Distance to nearest. Well : 7..... ---;,Fobndaiio-n...................­--- Property Line ........................ <br /> SEEPAGE PIT Depth .__.............. Diameter ------------------ Number......................-_.. Rock Filled Yes 0 No (:3 <br /> Water Table Depth .............­­­........... ..........I.,.,:.Ccck-Size _................. ------------- <br /> Distance to nearest: Well ...................... ........... Prop. Line -------- ---_----_- <br /> REPAIR/ADDITION{Prey. Sanitation Permit# ............................. Date ----.-----.--.--_------.----------) <br /> Septic Tank (Specify Requirements) ------- <br /> .. .............................I.........?­.................................. ............................. <br /> Disposal Field (Specify Requirements) ....A?.4-44y, WAP X . ...I......... <br /> ............................ ...... ..................................:---------------- ....... .............. ........ ................. .. ................................... <br /> ....................... ............... ....................... ------ ---------------­--- ----------------- -----------------­­.............. ... .... .......­......... <br /> (Drorw 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 Son Joaquin <br /> County Ordinances, State Laws, -a;nd. Rules and Regulations of the San Joaquin Local Health District. Home ownerer licew <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the w'ork,for,Nhich this permit is issued, I shall not employ any person in such mannor <br /> s to become subject to Workman's Compensation laws of California." <br /> Signed .:............. .... ...... ....... Owner <br /> A ... <br /> By ..., ... ........ . ...... i4l,-- w. ..................... .................Title . ..... ....... ......... ------- <br /> other than owner) <br /> FOR PEPARTM.ENT USE ONLY <br /> APPLICATION ACCEPTED BY ------(f...... . ..... .. ...... ............. ........­.......... DATE ------ <br /> ............................ ...... ........................._......._....--........HATE BUILDING PERMIT ISSUED .................... ..... .. . ...-DATE ................................. ......... <br /> ADDITIONAL COMMENTS ....... --••------•-----.....--------......I....-......... ..................I............. <br /> ................•............................. ............ .........• •-------------­ ......... .........­­­­­­------------...--.-.--.-.-.----....-------------•--•----. <br /> ..... <br /> -------------------------------I----- <br /> ........................ . -------­­­.................... ---------- ................................................................ <br /> ------------------------------ ------ -- <br /> .. ........ ------­­........ ....................... ......... ............. --- --------- ............ ------ <br /> 2 ...... <br /> Final Inspection by- ------- ........................................................ ----------- -------Date <br /> SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> 7 72- <br />