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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------ <br /> A........... <br /> (Complete In Triplicate) <br /> Permit. . <br /> ................. ..................... This Permit Expires I Year From Date Issued Date Issued '7.............. <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: <br /> JOB ADDRESS/LOCATION ..,.-..,...�45.Z-.ZZ!PY...Court.......................................................... CENSUS TRACT ................... <br /> Owner's Name ....Jo.e._.aAd..Xanu.e1s.L..Quin.p.n.e.o....... ....................... .........................Phone 24q765.9q............... <br /> Address -..-_,_.2452._Tro1y_Court................................. <br /> ................. City ...... ............ ------------- <br /> II <br /> Contractor's Nome ."pay"Le-s"...SLPti_Q..Tant ISeT ... # ...Z6173.7...... Phone <br /> Installation will serve: j Residence E0 Apartment House f] Commercial []Trailer Court 0 <br /> Motel [:]Other --------•-----------•----•--------------•--- I <br /> Number <br /> .............................7------------- <br /> Number of living units:-__1'....._ Number of bedrooms __3...-..:Garbage Grinder Lot Size -t7jt4..x..107..3............ <br /> . <br /> Water Supply: Public System and name 0alif.-Aftter..b_er.v--_1.QgL..qq ...... ........I.................................Private ❑ <br /> Character of soil too depth of 3 feet: Sand El Silt CIdy0 PeotO Sandy Loam r] Clay Loam 0' <br /> -Hardpan 0 Adobe fo Fill M6teriol ..._...... If yes,type....... ....... ............ <br /> ,(Plot plan, showing'size of lot, location of system In relation to wells, buildings, 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 TREATMENTJ ]1� SEPTIC TANK I ] Fx!L a t;1.ngSize................................................ L€quid Depth ..........................f <br /> Capacity --------------------- Type ...............------ Material....................... No. Compartments ...................... <br /> 0 1 . <br /> Distance to nearest: Well ....................................Foundation -_--------_------- Prop, Line ..................... <br /> LEACHING LINE JJ Nol. of Lines ----------------- Length of each line............................ Total Length ............................ <br /> 'D',`Box .-no..... Type Filter Material rock........Depth Filter Material <br /> ....................... <br /> Distance to nearest: Well 10.0.1:!...P.1%0.. Foundation 3,0................. Property Line ..S................... <br /> nrr+AGe++:F- De"p th 3.6t.............. Diameter ... ............ Number .....J................... Rock Filled Yes M No GIF <br /> t <br /> sump Water Table Depth .......................................Rock Size ...9*......................... <br /> 1� <br /> Distance to nearest. Well .10.01—P.I.U.13................Foundation ........... Prop. Line .. ............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit s# ............................................ Date ---------------------------------- <br /> Septic Tank (Specify Requirements) --- ----------------...-I-1..........­......................................... ........._—._.._.._.....-----...•. <br /> Disposal Field (Specify Requirements) ------------ ------ .......... ........ .............. ........ ............................................................ <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. Rome 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 Wpikman's Compen%5"n laws of California." <br /> Signed ---- ----- ----- ------------------------ Owner <br /> By IFT10 . O <br /> Title .....Co..nt.rI.ac..tor <br /> Chert n caner) e rhn. <br /> ............................. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- - - -- - -- ----------------•------------------------------------•------ _-------------- DATE .. ... .......... <br /> BUILDING PERMIT ISSUED" ...... .. -•-•----...-•.._........._--.-------•...................-------DATE------------------------------------------- <br /> ADDITI NAL COMMENTS --------I---------------------•---------•--•------•-----.....----•---...-- ...... .............I............ <br /> .............. ----------------------- - --------- - ----- --- - - ------ ..............................................................I......... ------------------------------- <br /> - -------------------- ------------­-- -- ------ -- -------- ------------- -•---•----•-•--------------_--------_...................... ------------------ <br /> ---- --------------- -- ---------------- <br /> --- - - --- -- ----------------------------------­--------- <br /> Final Inspe --------- ----- _Date ...... <br /> ............­­-------------------- <br /> EH 13 24 1 Rev 5M • <br /> SAN JOAQUINAOCAL HEALTH DISTRICT 8/7h 3M <br />