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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In T4111cote) 'Permit mo-7�6-,o........ <br /> ........... ........ <br /> . ............ Date 4syog <br />..................... ............. This.Permitte!T!I Year-Frons D0100 how" <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to constnict and -install the work herein <br /> described. This application is made In compli with County Ordinance No. 549 and existing Rules and Regulationst , <br /> 2 <br /> JOB ADDRESS/V <br /> e%Tfi NR r.t h Ldoti j. <br /> TRACT .......................... <br /> Owner's Name ..Rol.and..L....'Heard....................................................................Phone .... ----------- <br /> ...... ...... .. . ........... <br /> AddressAve. <br /> ....................................................................City .............................. <br /> .020 <br /> Contractor's Name ......................... Phone -------------- -------------- <br /> Installation will serve. Residence)4 Apartment House 0 Commercial OTrollor Court 0 <br /> Motel0 Other............................................ <br /> Number of living units:... ...... Number-of bedrooms ....3.....Garbage Grinder .y&-_5... Lot Size .....A2-Af4Qd................... <br /> Water Supply: Public System and'nome ....................................................__.........................._...Private <br /> Character of soil to adepth of3feats. Sand'p ­SIWE1­CIoY 13 Peat Sandy Loom_0 CJaytoam>2r <br /> Hardpan 0 Adobe O� Fill M6WIal ............if yes,typo............... ............ <br /> (Plot plan, showing size of lot, location df-system in elation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATIONs ANo septic tank or seepage pit permitted if public sewer is available within 200 feet,! sJ <br /> PACKAGE TREATMENT <br /> SEPTIC Sin.. ... ..... Liquid Depth <br /> t�14 .............i!� -7— <br /> TQ.5;�..... Typo .................. <br /> Capod <br /> a Compartments 00 <br /> Distance to nearest: Well 3 <br /> .............F*ndatlon .... ................. Prop. Line ...... <br /> LEACHING LINE No. of Lines ......3........ of each-11 Total Length ........ <br /> V Box TypeMaterial .......1..C6 ....................... <br /> filter Mated ..... .............Depth <br /> Distance to nearest; Well .... -------- Foundation ........ .......... Property Lim ........ <br /> SEEPAGE PIT Depth .................... Diameter ................ Number ............................ Rock Filled Yes 0 No (3 <br /> WaterTable Depth ................................................ROCk Size ................. .............. <br /> Distance to nearest: Well .......................Foundation ....14.0........ Prop. 'Lim <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ..:... .......... .. .......................... Date .................................. <br /> Septic Tank (Specify Requirements) ................... ..........................................I............. ..................... ---------- <br /> DisposalField (Specify Requirements) ..................................................................................................................................... <br /> .................................................................................................................................................................................... ................... <br /> ----------------------------------------------•--_..._..._.............. ..........................................I.........................................................I.................... <br /> lDraw existing and required addition on reverse side) <br /> I hereby codify that I have prepared this application and that the work will be don* In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HooW District. Homo owner or licew <br /> sod agents signature codifies the following: <br /> "I codify 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'beco bled to Workman's Compensation laws of California." A <br /> Signe4 .. ...... ---------------------------------- Owner 44 <br /> ...... ........... o. <br /> By ----- ------------------------------------------------------------------------------------------------- Title .......................................... ............. <br /> (if other than owner) <br /> -FOR, DEPARTMENT USE ONLY <br /> AZI <br /> ;00.r"e <br /> APPLICATION ACCEPTED BY .... .. . <br /> ---r—e-14ij ......... ......... DATE ........ <br /> BUILDINGPERMIT ISSUED ........ .......................... ........... ......................... ................--._..........DATE . ... ........ ............ <br /> ADDITIONAL COMMENTS ------- .............................. <br /> .................................................... ........ ........ ...... ------­------------------­­......................... <br /> - <br /> -------------------------- - -­-------------- ................................................ ............. ................................................................ <br /> -------------_---- ........... ------- - <br /> ----------------------------------------------------- <br /> --------------------------------- ' ............ <br /> Final Inspection . ...... ................................ -;� o 10;,�?x.-A7z . . . <br /> EH 13 21l 1-68 5m <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />