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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................. .......... = s Permit No. .............26-C C..... <br /> _. <br /> (Complete in Triplicate{ <br /> DId <br /> ...........m.............. ...... ....... This Permit ExpI!#ij Year From Date Issued ate ssue <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application is made in compliance with County Ordinance Na'. 549 and existing Rules and Regulotions: <br /> V <br /> JOB ADDRESS/LOCATION -------16;-;fZ1­.-e.-.CENSUS TRACT Ag .................. <br /> O.w.ner_*s_Name_ _6__ ...................................................PhoneZ2:72e�?7.44......... <br /> _c _ ....... <br /> Address ------------ .......... .........I............city ------------------------------------- <br /> Contractor's Name -------------------------­----------- ........... <br /> Phone <br /> Installation' will serve: Residence[]Apartment House 0 Commercial)<Tralier Court 0 <br /> Motel []Other.._..._,/............................... <br /> ber-olf living uniti:.../... umber of bedrooms ......:...__Garbage Grinder ............ Lot Size ....... ------------------------------------ <br /> Num N .� <br /> I <br /> Water_supply.-Public-S`'ystem and name ..............................1----•----------•----------------...........................................Private <br /> Character of soil to a depth of 3 feet.. Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loom 0 Clay Loarrilk <br /> Hardpan g . Adobe 0 Fill Material ............ If yes,type............... ............ <br /> Mot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f SEPTIC TANK I Size ............................... .Liquid Depth .-------•----_........----. <br /> VpeA".e.A4-19__ MaterialA rt7,AjeCA!9_tNo. Compartments t <br /> Capacity/. ------- T1 .......... <br /> Distance. to nearest: Well ....115;�)--------- .........Foundation _AS.....+..... Prop. Line _J�G.............. <br /> LEACHING LINE No. of Lines ....../.............. Length' 2 each line .. <br /> ........ ... Total Length _..7. _rrK.................. <br /> 4 <br /> 'D' Box ........ Type Filter Majeriall ..". W_ c0epth filter Material _111V............................. <br /> Distance to nearest: Well _L <br /> - ------- ...... Foundation Property Line ............ <br /> SEEPAGE PIT De pth 199----*.--. M14mmaer IONZI..... Number ....._Y__------------ Rock Filled. Yes No (3 <br /> Water Table Depth ••----------•--.....--•----=••.............•--..Rock Size/X4.=.Z.."I'd <br /> Distance to nearest: Well ---- .......................Foundation a9P.......... Prop. Line -.9.... ....... <br /> REPAIR ADDITION(Prev. Sanitation Permit .___---------------- lj_�_Datq -----_-- <br /> Septic Tank (Specify Requirements). ------------------­1......­........ ..... ........... <br /> ..............-.....-•-•-•-••-•-..............._.-•----.......... <br /> Disposal Field (Specify Requirements) ............................................ <br /> .....................­­­........ ........ .........---------------------- ........ <br /> ------------------------------------------------------ ---------------------------- ---------------------------------------- ----------------- ..........I.................•------.....-•----- ........ <br /> • `I------------------------------------------------- _1-1 <br /> - 1_ `�-------------------- .......................... .......... <br /> .'(Draw existing and required addition7citi revirie`ilde) <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, anil Rules and Regulations of the icm!,Jo6qulln Local Health,District. Home owner or licen- <br /> sed agents signature certifies the A4 <br /> " <br /> "I.certify that in the performance of the work for 1,shall not-employ.6inir person In such <br /> which this permit is Issued, manner <br /> as to become sub jp# to Workman's Compensation laws of California." <br /> Signed ....................----.___....• �� <br /> t <br /> _ --- . .....Owner <br /> By ........ ---------- ---_- --­ --------------------------------------------- it e ---------_------ <br /> ............... ------------------------------------ N, <br /> (if other than owner) <br /> VIC 11 <br /> D RTMENT IJSV�O"LY <br /> EPA <br /> -------------------- •............. ­........ <br /> APPLICATION ACCEPTED ---------------- A DATE <br /> BUILDING PERMIT ISSUED --_------------------ ...... ........ ---------------------------..------DATE ......... ...... ---------­----- <br /> ADDITIONAL COMMENTS ----------------------------------- - <br /> -----------------------------------------------­.­­W1-------- <br /> ------- ...... ...................................... <br /> ------------------------------------------I-----------­1 ----------•----••-------------­­--­-------- -- --------------------------------•---------------------•-• <br /> t _,�i , <br /> ------------------------------------------------- <br /> -- ...............­­---------------------------- ---------------- ---------------------------------------------------------- <br /> -------------------------- -­ - ----- -- ---------- --------- - - ------------------------------ . ........... <br /> ----- -------- u <br /> ---------------- .... ... • ....... ...............Date ._Z7­.71.&/1........... <br /> Final Inspection by- -------- -------I.............. 7. <br /> . .... - --------- <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQ Lokk HEALTH DISTRICT 8/74 3M <br /> ai A <br />