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FOR OFFICE USE.. -APPLICATION FOR SANITATION PERMIT <br /> _0 -_2 Permit No. <br /> 2 ----------- ------- <br /> --- ----- -- (Complete in Triplicate) <br /> --------- Date issued <br /> --- <br /> This permit.Expires 1 Year From Date Issued <br /> ----- ----------- <br /> ruct and install the work herein <br /> tion is hereby made to the Son Joaquin Local Health District for a per'mit to const <br /> Applica No 549 and existing Rules and Regulations: <br /> described. This application is rn�oe in compliance 'th County Ordinance <br /> ---------------CENSUS TRACT -------/�------------- <br /> JOB ADDRESS/LOC TION / .. <br /> o5l <br /> _A�------2 -------------- <br /> Owner's Name -------_--------- ------ -----------I--------- -----Phone ------------------------------------ <br /> _�4,ow---------------------- ----------------_-- <br /> yf --------------------- --------__ city ; '; ---- Phorte <br /> D <br /> Address <br /> y�4 c�w __j_)4oqtPV_e6vcense <br /> Contractor's Name <br /> Ioniffierdence VApartmenf'House❑ Commercial i[:]Trail&Court 10 <br /> Residence �171 <br /> Installation will serve. Motel E] Other -----------I--------------------------------- <br /> _—.4 t Size _Add.X Ia ----------- <br /> Number of living units: Number of bedropmsj--------Garbage Grinder ------------ Lo .lk <br /> name y Clav <br /> - --Private 0 <br /> Water Supply: Public System and A-------- <br /> Character of soil to a depth of 3 feet: 'Sand Clay C] Peat El Sand y Loam ,E] Cla� Loam .R <br /> Hardpan F-1 A8obe-E] 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 permi;e-d'if public sewer is available within 200 feet,) <br /> V\ ------ Liquid Depth,----------------------- --- VV <br /> PACKAGE TREATMENT f I SEPTIC TANK[ I Size--------------:-------------------- ------ Ir <br /> Capacity ------------------ <br /> - -- Type ' <br /> Material -------------- <br /> No. Compartments ....... -------------- <br /> N ----------------- Prop.,Line ---------------------- <br /> Distance to nearest-. Well ------------------------------------Foundation <br /> . ........ <br /> /44.! Total Length` -----T_��_ <br /> LEACHING LINE No. of Lines -------/--6 - ----------- Length of each line-- OY ...... <br /> As C1 Material 1 ------------•-------- -------- <br /> 'D' Box e------Depth Filter M te I <br /> --------- Type Filter Material K on 14d-------------- Property Line _' -•--._...----- N <br /> Distance to nearest: Well <br /> ------ Foundation <br /> Rock filled YPsR No [3 <br /> SEEPAGE PIT Depth _SVJII"�6 Diameter .3j------- Number <br /> drIc".1------------ 10 A <br /> Water Table Depth -0-0----------------------- Size Prop. Line -11 ............. <br /> ell Jvew_4------------------Foundation _1/!'0_--- P-------- <br /> Distance to nearest: W <br /> *WAfR/AMTJ0t4(Prev. Sanitation Permit# ---&­O-dvt_---- -------------- Dote --------------------------------- <br /> .09 -- ----11----------------------------- <br /> Septic Tank (Specify Requirements) ---------------t__ <br /> ------------------------------------ ------- <br /> 4 4:f, ---1_10e*!.--4 --------------------------------------- - <br /> Dispos I Field (Specify Requirements) 4V- <br /> /.. <br /> 2 7 0 ----------------------- <br /> (r - ---- _e----- <br /> r <br /> ---_-!947 <br /> ------- /09 <br /> ---------------------------------------------------------------------------------I --------------- ------ <br /> -------- ---- -- - <br /> -- - - - -------- <br /> ------------------- ---------------- ----------------- Draw-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, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: for which this permit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work <br /> as t b <br /> a ec 9 e subject to Workman s am ensation <br /> of California." <br /> Signed ---- ----------------- <br /> ----- <br /> Title —---------------- <br /> By if-o-ther-than owner) - -- - ----------------------- <br /> PARTMENT USE ONLY <br /> DATE ------- ------------ <br /> APPLICATION ACCEPTED BY ------ --------------------------------DATE ------------------------------------------- <br /> BUILDINGPERMIT ISSUED -------- ----- ---- - -- ------ --- ------------------------- ---------- ------- ----------------------------------------- <br /> ADDITIONAL COMMENTS ------ - - ----- --------- --- ------ --------------------------------------------- --- <br /> - ----------------------------- ------------------------------------------------------------------------------------------------- <br /> --------------- <br /> -------------------------------------------- -------------- ---- -------------------------------------------- ------- ----------------------------------------------------------- ------- <br /> ------------------ ----------------------------- - ___ - ___ -------------------- ------------------- <br /> - <br /> -i <br /> ---------------------------------------------------------------------------------------- - ------- <br /> -7 ---- -------- <br /> Date V <br /> Final Inspection by: --- -------- ------ ------- ----------------------------- <br /> AN AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />