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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7-,'-- '_13 <br /> 1. Permit. No. ............ <br /> ...... ...... ...... (Complete in Triplicate) <br /> Date issued <br /> This Permit Expires I Year From Date Issued <br /> .................L......... ........................ <br /> Applicot.i! n is hereby m.ade to the Son Joaquin Local Health District for a per'mit to construct and install the work herein <br /> i app icc <br /> describe Ii 3tion jo2mcide In compliance with County Ordinance NO. 549 and existing Rules and Regulotionso <br /> 00 <br /> 0 A 01.� <br /> .4r�...CENSUS TRACT ....__...... ....... <br /> ........ ..&d_= <br /> JOB ADDRESS/LOCATION /*-)vt4...n,4.. .... -- --- - <br /> 7___ ...-L...Phone .......... ......................... <br /> ..........................r........... . <br /> Owner's, Name <br /> City <br /> ................... ................... <br /> ........... ........ <br /> ............ Cit <br /> Address: --------------- -- ---- . ..... <br /> ....License # J, <br /> Phone ............................. <br /> Contractor's Name ........ . ..... . ...... <br /> .11, -. Residence Apartment House 0 Commercial f3Trailer Court 0 <br /> Installation will serve. .��l <br /> Motel C]Other --------------------------=-•-•-••••--..•-• <br /> Number of living units:..-I....... Number of bedrooms <br /> _-...Garbage Grinder ............ Lot Size <br /> ........Private <br /> Water S ply: Public System and name ........ ---------­..,.......... amgj--elay Loam C1 <br /> 11' clay [3 Peat C3 Sandy Lo <br /> Character of soil to a depth of 3 feet: Sand 0 .Silt 0 <br /> Hardpan 0 Adobe,-C] Fill Material .......... If yes,type ....................... <br /> reverse side.) <br /> .1k <br /> (plot pl.6, n, showing size of.lot, location of. system in relation to wells, buildings, etc. must. be placed on. <br /> P. (No septic tank or seepage pit permitted if public sewer is available within 200 feetJ <br /> NEW INSTALLATION. size-...!� ....................... ----_------ Liquid Depth .......................... <br /> PACKA& TREATMENT SEPTIC TANK( ] - . .Compartments ................ <br /> Material...................... No. <br /> ------:777,=TVISe -------- <br /> Capacity <br /> Foundation ....------••--•--•--•- Prop. Line ...................... <br /> Distance to nearest. Well .................. <br /> 6 ---- Total Length ............................ OQ <br /> -ength–of-ofeach--li I'Ve—------- <br /> LEACHi G LINE 11 No. of Lines ----------------- =L ." t <br /> .......... <br /> V Box .----------- Type Filter Material ........ Dep h Filter Material <br /> Distance to nearest:.t- Well ......................r Foundation -------_-------------- Property Line ........................ <br /> iY , <br /> ....... Number ............................ Rock Filled Yes [3 No <br /> SEEPAGE PIT Depth Diameter ......... <br /> ­.-I............. Rock Size ... ....... .............:...... <br /> Water Table Depth–........................... -- I <br /> Distance to nearest. Well ------------- ..........................Founcf6tion .................... Prop. Line .......•.. <br /> . .... Dote ----------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit -•••---•.......----- . C. <br /> V, <br /> ............. ........................11....... ........... ........... ...... .......­................ <br /> Septic Tank (Specify Requirements) -...................... -------- .........:=............ <br /> sol Field (Specify Requirements) .....�__ <br /> -------------- <br /> .............I----------- ... ...................... <br /> -------- ....... ............................................ ------- ........................ <br /> ------- - ---- (Draw existing and required addition on reverse side) <br /> hot the work will be ;9 in accordance With Son Joaquin <br /> I hereby certify that I have prepared this application and I <br /> aquin Localdonealth District. HOMO owner or licen-, <br /> County Ordinances, State LOWS, and Rules and Regulations of the Son JO <br /> sed agents signature certifies the following- sued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work for which this permit is Is <br /> as to become subject to Workman's Compensation laws of California." <br /> it Owner <br /> Signed --_----_-----------------­-A- e Jg� ......................... ................ <br /> ------- ........ Titl �,----------_--- <br /> By ------- <br /> {If other than owner) <br /> 0! FOR DEPARTMENT USE ONLY <br /> E............... DAT .............................. <br /> APPLICATIONACCEPTED BY ... �.............. ................... DATE ........................................... <br /> .......... ..... <br /> BUI -I PERMIT ISSUED ..... .............................. <br /> Ld NG -•-•--.................................I.......... <br /> :1 <br /> ADDITIIONALCOMMENTS .................. .................................... ............ .....................I.............................. <br /> ............ <br /> ................r...............I.......... ............... ....... ................................... <br /> .............. .............. - -------------­-- ....... <br /> ................................e7.............. ............................. ........ . ............... <br /> ........... <br /> ................. 0.._....................-------------• ........ ............ <br /> ............ <br /> .....................; ­ ... .. ... .. ....Date . .... <br /> _......... ..............1.............I........ ............. <br /> Final.;Inspection -./, <br /> SAN JOAQUIN AOCAL' HEALTH DISTRICT <br /> 7/72 3��� <br /> :13 24 1-*An va%, -rim <br />