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FOR OFFICE USE- <br /> ......I................ APPLICATION FOR SANITATION PtRMIT <br /> lComplete In Triplicate) Permit No. <br /> ....................... . <br />.......... .......I..........I.......................... This Permit Expires I Year From Dot*Issued Date Issued ........... <br /> Application is-hereby made to the Son Joaquin Local Health District fora-permit to construct <br /> ct and install the, work herein <br /> described. This a plic lien is made in compliance with County Ordinance No, 549 and existing Rules and Regu!otlons- <br /> JOB ADDRESS/LOC­ TION ....... ...... ENSIJS TRACT .......................... <br /> ............ <br /> Owner's Nome .�ep_r- f); - <br /> . __ I .1—................ ................ .---..Phone-791/ .2_?�13­ <br /> 0 '. 57- / X - 1... % <br /> Address . . ..p ...... .......... <br /> city .............................. ........................ <br /> Contractor's Name -------- ........................... . ...............License # .................. Phone .......—.................... <br /> Installation will serve. Residence Apartment Hous <br /> e 0 Commercial oTrailer Court C] <br /> Motel E]Other -.'............. <br /> ....... <br /> Number of living units .1..... Number of bedrooms ..3------Gdrbage Grinder -3 .12 Lot Size ......................... ..rte <br /> Water Supply, Public System and name ...... -------------••--.............------- <br /> : . d f <br /> ...........................­--------- .................................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 .. Cl cY Cj Peat Ej�:.'Sandy Loam V clay Loam 0 <br /> Hardpan [I Adobe 0 Fill Material ..L....:`. If Yes,type....... ....... ............. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW-W INSTALLATION: (No septic tank or ieepage pit permitted If p6bfic'sewelr Is available within 200 feet,) <br /> PACKAGE TREATMENT f I SEPTIC TANK TX Size ----- f . ..... Liquid Depth .........I 4...... <br /> Z N <br /> ... .... ... Z- <br /> .. <br /> Capacity 12,Pk')..qAY Type. MreW. Material.. No. Compartments . ......2. .......... <br /> r Zo r-14 <br /> Distance to nearest: Well Foundation ......... Oje-w- <br /> bl- ........ Prop. Line ...... ...... ....... <br /> .... Length of each line..-- Total Length ....... <br /> LEACHING LINE, No. of Lines --------- ------••--.... <br /> Material ....�7 ......Depth Filter' Material ......... <br /> Box. e Filter Mater ................ ........... <br /> pistons/- to- nearest. Well Foundation ...IAA. �.... Property Line .... <br /> SEEPAGE PIT I Depth --------------__ Diameter ................ Number ...I——..........L......... Rock Filled - Yes C) No 0 <br /> Water Table Depth .................:.......... ...................Rock Size ................................. <br /> Distance to nearest: Well ........................................Foundation <br /> .......................................Foundation ............... Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------..Date ---- ........... ................ <br /> Septic Tank {Specify Requirements). ......................._------------------------------------- - <br /> .......................... ....................... ............................ <br /> Disposal Field (Specify Requirements) ........................ ................ ............. ............................. <br /> .................... <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. Homo 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 no, employ any person such manner <br /> as to beco josubi6cl to WY ompe anon laws of California... <br /> _ <br /> Signed -- --- <br /> . ...................................... Owner <br /> By <br /> '-Jitle ......... <br /> -------------- --------- ----------------_--------- --------- <br /> J(If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... <br /> DATE 17--; " '�7 <br /> By-- <br /> ISSUED ........................... - ---------I- <br /> ---------------- .. ........ _..................................DATE ... ........ .................. <br /> BUILDING 'PERMIT -7 <br /> ADDITIONAL COMMENTS --- . ....... . ..... <br /> ­�-------------------- ...............__....................I------ -----•------...---.-...---•--•---._...__...... ..........­­­.............. <br /> - -_------------ ---------------------- ....... <br /> --------------------------------- -- -----4--- :' Z .......1_1........ <br /> ...... -------- - ----------------- ---------------*----------------------------------------------------------- <br /> Final Inspection by- -------- ........I-----------------------------------;' e <br /> EH 13 24 1-68 Rev. ........ ------Dot <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />