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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..............-....................I------- Permit <br /> fCompl*fe In Triplicate) <br /> .......... ...... <br /> ••---•-----... <br /> .......... ......... ...... ............. .......... This Permit Expires I Year From"Date Issued Date .................... <br /> Application is hereby made to the Son Joaquin Local Health District- for 6 permit to construct and Install the work herein <br /> described. This application is made in compli nce with County Ordinance No. 549 and existing Rules and Regulations: <br /> Sierra Lane <br /> SU. <br /> 4 <br /> JOB ADDRESS/LOCATION --------- ............ ...... ............... .......... SUS TRACT .................... <br /> Owner's Name Ja nie.--Winahell.................................... ...••--,--...._..............................Phone <br /> - ............_....__........_......--- <br /> Address <br /> 3835 Ee- Main City I <br /> . R0t0, A6ot --------- .............. 2' 1 . . 46t126J6.......739 <br /> Contractor's Nome ---------------:................... ---------------------_- --_---_-------License ................... Phone ......................... <br /> Installation will serve: Residence 6[o Apartment House 0 Commercial OTraller Court C] <br /> M6*10Other .. ......................... <br /> 1 1 2--- yes 501. ..1001 <br /> Number of living units:------------ Number of. bedrooms Grinder ............. Lot Size ...... <br /> Water Supply: Public System and name _,..'-G-aWV---W-Atre�...S-et­w------- ..Private <br /> Character of soil to a depth of 3 feet.. Sand 0 Silt Q ClayTo Peat 0 - Sandy Loom 0 Clay Loom 0 <br /> Hardpan E) Adobe 1J Fill Material ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildingsr'etc. must be placed on reverse side.) <br /> NEW INSTALLATION:. (No septic tank or seepage .pit ;permitted if public-sewer is available within 200 feet,) <br /> PACKAGE TREATMENT, f I SEPTIC TANKS Size---.}.'- Liquid Depth ---- <br /> ...............-. 4��-'1 1 ................ <br /> 120OR Material.-concrete -ts 2, <br /> capacity - --------­......... TypePEa:�C.as.t. .................... No. Compartmen ...................... <br /> Distance to nearest: Well _Rq-....................;.......Foundation 10­1............ Prop. Line .. .................. <br /> LEACHING LINE No. of Lines A....::_____-____..'' Length of each line..19 0 ....... Total Length .1.001.................. .P� <br /> V 'Box 1l9------- Type Filter Aka­ierial rock.....__.Depth Filter Material ..........11-a.".......I......................J <br /> Distance to nearest: Well d. ---------- Foundation1............ .... .... Property Line .......... ............ <br /> SEEPAGE PIT fxj Depth 25-t•......... ... Diameter6,n..... Number ... ..................... Rock Filled Yes No CC] <br /> -3 - <br /> Water Table Depth -----------A/.4...... ...................Rock'Size .-bY �!'. .......... 0 <br /> n/a 10-L <br /> Distance to nearest: Well ............... ......................Foundation .................... Prop. Line ............. ........lb <br /> REPAIR/ADDITION(Prev. Sanitation Permit;p _..............__•--........"..._....---- ... Date ................"..__..............I I <br /> I ._..I _.. A <br /> SepticTank (Specify Requirements) .........I................. ...... .................... ............ .......................__........................... <br /> Disposal Field (Specify Requirements) ............... <br /> ----------- ........................... ---------------------------------------------------- <br /> .........................­­-------­-­---------- ---------------------------------I---------------------------- ..................................................... ....... ...... ------ <br /> ----------------- ------------------------------I----------- ------­---------------!--------------- --------....................­---------------------------------­............. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application-and that :the_workwill- be.done-In-accordance—wilh-Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heol&DIstdcf. Nome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify 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 become subject to Workman's Compensation laws of California." <br /> Signed _ ":,----- .-•------- 4�----------------- Owner <br /> ---- ........I------------- <br /> By __-------------- ......... -------- <br /> ......--•------------ -­-------- Title _.............Con.tr-actiar.--- -------- .................... <br /> .f other than owner) <br /> FOR DEPARTMINT WE ONLY <br /> APPLICATION ACCEPTED BY ---------0,ef <br /> .......--- ---- ....... DATE <br /> BUILDING PERMIT ISSUED _.:'-------------------- --'• ............ .......... ......__.._DATE -_---------------- ........ ...... <br /> ADDITIONAL COMMENTS ------ -------­--- ............................................. <br /> ................................. <br /> ----------------- ---------- <br /> ------------ -- ...... <br /> ---------- - --- <br /> ----------------------------------- <br /> ;U I - ..let,W. ----- ....... k,-r-t. . ......................... <br /> ---------------- ---------P .............. V� <br /> ...... ...... --- ------­.­. ... ............ -----V------- ---------- ........................ ................14---------��. <br /> Final Inspection by: --------___ .. _ 7y....... <br /> ................................. ........................Date .... . . ........... <br /> EH 13 2h 1-68 Rev. 5M SAN JOA UIN LOCAL HEALTH DISTRICT 8/711 3M <br />