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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate} <br /> .................................... <br /> ........... ----- <br /> .................r.. ..................:.......... This Permit Expires I Year From Date Issued Date Issued . - <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 Regu'lations: <br /> JOB ADDRESS/LOCATION ---------AJ-`--------.-CENSUS TRACT <br /> Owner's Name ---------- ---_------__--------- .........................Phone --------- <br /> Address Vj6... ......__.. ................. ------------city --- <br /> -------------- ------------------- <br /> ------------- <br /> Contractor's Name ---- -------0&. ` 011:49( c5p�'_ Phon ?193-:-----------....... <br /> Installation will serve; Residence E]Apartment HouseC] Commercial:E]Tra I ler Court :EJ <br /> Motel [-1 Other ------------------------------------ <br /> Number of living units ..... Number of bedrooms ...._.....Garbage Grinder ---------- Lot Size ---- <br /> Water Supply: Public System and name ----------------------- -- -------------------_-------............................ .........................Private <br /> Character of soil to a depth of 3 feet: Sand j] Silt El Clay El Peat E l Sandy Loam 0- Clay Loam. <br /> Hardpan ❑ Adobe ❑ Fill Material 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 seepa��pit permitted if public sewer is available within 200 feet,) <br /> i 1/ 16 L <br /> PACKAGE TREATMENT SEPTIC TANK Size. ............ .... Liquid Depth Z---.-.-_----_ \4 i <br /> - 00.40 00 <br /> Capacity 16*T-7P..... Type. .... .1� Ma1­erial..(fft.atJ&4__ ._ No. Compartments ............... <br /> istance to nearest., Well ......_,5 / - _0_f.--------. Prop. Line ---��11 ...... r4 <br /> ................. ---Foundation <br /> 4e <br /> LEACHING LINE No. of Lines __J.............. Length of each line...... Total Length <br /> V Box/%�_ . Type Filter Material-.P-.*4 __Depth Filter Material ­---------­--------- <br /> .............. <br /> ------- Property Line L <br /> Distance to nearest: Well I---- -------f-----I.... Foundation ... <br /> Fl L-T-eiz, tw .1 1. <br /> SEEPAaE pgf P Depth fir......_.__ Diameter Number"_---- Rock Filled Yes [R No 0 <br /> 11 1 --------- 1.r/,0" <br /> fi <br /> Water Table Depth __ - _/ size 1 <br /> .0 _-----------------•--------Rock Rock ......... <br /> Distance to nearest: Well ---------------- -- --_----------------Founclati --------------­----- rop. Line ------ ............... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ---------- Date ------- -------------------------- <br /> SepticTank (Specify Requirements) ------------------------------------------------------------------- ...............__--------_------------------------------------- <br /> Disposal Field (Specify Requirements) -------•-_------------ ----------------------------------------------------------------- --------- ---- -----_--------_-------_ <br /> ................................................ .. - ------------------------------------------ ----- -------- ----------------------------------------------------------- ........................... <br /> ....................................................... ---------------------------------------------------- ................................. ......J_-----------------_-- .................. <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 San Joaquin Local Health District. Home 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 ------- -- •------------------ Owner <br /> By -------?'J'04 � -;_-� ----- --- --------- <br /> I-------- -- -------------- .................. Title ------------ .................. -- -- -- ---------------- ------ <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_T7AR_�V-------------------- ------------ ----------- ------- DATE ... I. .7.-------.......... <br /> BUILDING PERMIT ISSUED ................ ­_.__­------ ---------------­--------- ------=---...........DATE ... ---------------------------------- <br /> SS <br /> ADDITIONAL COMMENTS ----------_ ----__---- --------------- ........ ... ........ <br /> -- --------- <br /> .............................Date <br /> ..........................__........... .............------- <br /> -----------­---­---- -- -------- --------------------- ---- -- -- -------­---------­-­-- ........... ............... --------------------- --------- <br /> .1.... . . ... --- ----- -- - ---- --- -------------------------------------------------------------- <br /> - -----------------------------------------*---- <br /> .............. ............. ----------------- <br /> ......................I............. <br /> ins -- ----------- ----- <br /> --------- ---- ---- <br /> IFinal Inspe <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 511, <br />