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'FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............I...................... <br /> ,7:----------...-•----- k <br /> Permit No. ...... <br /> ....... (Complete in Triplicate) <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 County Ordinance No. 549 and existing Rules and Regulations: j <br /> jOB ADDRESS/LOCATION M— ,491 V 7 7...�U7'?a............. ......CENSUS TRACT ........................... <br /> Own6r's Name ......A MV-1 <br /> .... .............. ................... ..........­............... ................ <br /> .....Phone ....... <br /> Address .................... <br /> ........... .........._ city .......... ........ ........ ................. <br /> Contractor's Nome Z-_71_37_2411 ---- ..........License # 17769.-4... Phone <br /> Installation will serve: Residence 0 Apartment Ho'useo Commercial ClTraller Court C1 <br /> Y. <br /> Motel 0 Other.......... <br /> ..................... <br /> Number of living units:.­7..... Number of b6drooms .....4/...-.-Garbage Grinder A10...- Lot Size -"......... ....................... 4. <br /> Water Supply. Public System and:name -- ............. .......... <br /> ..........................................private <br /> ❑ <br /> Character of soil toa depth of 3 feet: Sand_0_-,, SiIt0 Cloyo-- Peat[] SondyLoamo Claytoomo <br /> Hardpan [3 - Adobe JO Fill M6terial .­­ .... if yes,type ............... ............ <br /> (Plot plan, showing size of lot, location of sys ,, <br /> 'tem,Iin reldtion to 'wells, buildings, etc. must be placed on reverse side.114) <br /> NEW INSTALLATION: (No septic tank or seepage .pit perQtted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT_ SEPTICTANK-1 Size....... ........................................ Liquid Depth .......................... <br /> Capacity -------------------- Type ....... ............r,4,Materia I................ ...... No. Compartments ....................... <br /> Distance.to nearest: Well-,...................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE No. of Lines - ------------- Length of"each line.__. <br /> ............ Total Length ............................ <br /> 'D" Bak7 Tyj5e Filter Mcitericil -------------_----Depth Filter Material ....._..............I....................... <br /> . 41 <br /> -to nearest, Well. <br /> m .........................Foundation.................. ...... Property Line 1 <br /> ................ <br /> SEEPAGE PIT _704OK-7777=--- Diameter ............... . Number..........1.......I....... Rock Filled <br /> Yes 0. Na (:3 <br /> Water Table Depth --------- .......................... ------------Rock Size .............................. <br /> Distance to nearest: Well ..................`..__..._..............Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> ---•-•-•---•.•--- ----------------------- Date ................................. <br /> Septic Tank (Specify Requirements) .............................. ............ .....--------._......I.....-.. <br /> Disposal Field (Specify Requirements) ------ ----------- ...... .. ............. <br /> --------------------- --------------------------------------------­----- -P.X ......./--40JC#... <br /> 1k.4 <br /> ...........­................ <br /> ---------------------I------------------ ------------------------------------------------- ----------­--­........ .............. --------------------­- ................................... <br /> {Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this 'application wind 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 Realth,01strict. Nome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance-of-the-work for"which this per In'it is issued, i shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............................ •-- . <br /> .. ....Owner <br /> By ---- --------------- -----­ itle . <br /> --------------- 141,1 A <br /> _VR --- .. <br /> -- -------------------------------- <br /> (If other than owner) <br /> F DEP ARTME hil SE ONLY <br /> APPLICATION ACCEPTED. BY ----- --- ---------- ................ DATE <br /> _.q <br /> Z41 <br /> BUILDING PERMIT ISSUED ........... <br /> -------------- ------ ------------------ ------- -------- ............DATE ........./........f__�........ ...... <br /> ADDITIONAL COMMENTS <br /> ------------------------------11------------1_1­11- <br /> F ------- ---_ -- --••- ------•--_/- --- <br /> . ... <br /> ----------------------..---.--.---.-..--...-..-...-.-.....-.-..-..--.-----------------------P-------------.-.--.--.--.--.- <br /> -.-.-.-.-.-.- <br /> ------- - / <br /> 2 <br /> ------------- ­ -------- --- - . .... <br /> inaInspection by: ------- ............................................"...Date .... <br /> EH 13 21-68 ........ <br /> 5H SAN joAom LOCAL HEALTH DISTRICT 3M <br />