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10Rt7FFICE USE:. <br /> APPLICATION FOR SANITATION PERMIT tj <br /> 1 i Permit No.;7.j <br /> ............*... ............................--------- (Complete In Triplicate) <br /> . ....... ......_------- .......--- Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work Ijerein <br /> described.This application is made in compliance with County ordinance No. 549 and existing Rules and Regulations: <br /> 71 <br /> ---...-CENSUS TRACT .------S_-/ <br /> JOB ADDRESS/LOCATION <br /> ..... .. .....Phone <br /> Owner's Name �&e�.......4 �aeoz.� ­­­­ I--- <br /> Addr6ss _-------_--- city ....... .................. <br /> Contractor's Name s4n�- ------ ....... -----­-----------4........License ------- -----------... Phone ..... ........... <br /> Instal.lotion will serve: Residence JET'Apartment House 0 Commercial{]Trailer Court 0 <br /> Motel f <br /> -10ther,....... ......_---------_------------ <br /> Number of living units __.L.... Number of bedrooms ._......,..-Garbage Grinder ...... Lot Size .................• --..:--•-----•-:•...... <br /> �q <br /> Water Supply: Publilisystern and name ---------- -_-------------............................ .............................__.....Private [I <br /> ,' <br /> Character of soil to o'clepthof 3 feet: Sand[] Silt 0 Clay [} Peat ffASandy Loom 0 Clay Loam <br /> Hardpan F-1 Adobe C] Fill M6terial .... If Yes,type----- -------------------- <br /> (Plot.plan, showing size of lot, location of system in relation to wells, building side,) <br /> s, etc. must be placed on reverse sI <br /> NEW INSTALLATION: (No septic tank or sLepag , pit permitted if public sewer is avail ble within 200 feet,) <br /> ----!. ..... Liquid Depth ._------ <br /> PACKAGE TREATMENT [ I SEPTIC TANK[ ] Size..___------------------____ I men <br /> .... <br /> Material....._-------_------ - 0- Camp <br /> 'Capacity .................. Typ ...--------_--- 7t F <br /> Prof. Line ........ <br /> Distance for nearest. Well --------------- -------­......-Foundation - ----------- <br /> V, --I ` <br /> • LEACHING LINE [']' No, ofl. ;------------- --- Length of each line.._ -- -, .... Total Length ---_--------_-- <br /> ---Yype- Filt Material _. lath Filter MAC enol --------­------ ................. <br /> 'D,"0 1 ........... ......De <br /> Distanceto- -Well- �........... .... Foundation ------ ... Property Line <br /> nearest --- <br /> Rack Filled Yes 0 <br /> SEEPAGE PIT Depth ........ Diameter Number.-- <br /> ......Rock Size ...... ----_------ <br /> WatertTable Depth ................. <br /> Distance to nearest: ZI ................___.......__--...Foundation . .....­­ Prop. Line <br /> -----------­-----=...........DbW=-'­- ----- ------- <br /> REPAIR/ADDITIONtPrev. Sanitation <br /> Septic Tank (Specify Requirdments) .... .................... ------......__------------ ...... <br /> Disposal Field (Specify Requirements) ------- <br /> -------------­-­-------------- ......24 <br /> .............. .......... <br /> ------------ ............. ---------------- <br /> ----------- ------ ---­_................. . <br /> ........V--.............. .... (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will. be 'dome in accordance with Son 10"uin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin-Leval 14valth District. Home owner or.11con- <br /> sed agents signaturecertifles the following: erson in such m <br /> any p <br /> Iarmor <br /> "I certify that In the performance of the work for which this permit is issued, I *hall not employ C <br /> as to becorlie subje4 to W rills Compensation laws of California.'! <br /> �Owner� <br /> - ---------- <br /> SignedA77 <br /> By....... ­.­............... ------ .... ..............­­­............____ Title ... ............__.......... ----- ------- <br /> (If other than owner) <br /> FQR DEPARTMENT USE ONLY <br /> DATE --------- <br /> APPLICATION ACCEPTED BY----------- ---------- . ....... ...................... ............. T ---- <br /> BUILDING PERMIT ISSUED ------­----- ­­............................... ----------- ---------......DA E- - -------------- -- ------------ <br /> ----------------- <br /> ....................... <br /> ADDITIONAL COMMENTS <br /> NTS. ...........• ........ ------------ <br /> -------- ­ ..... <br /> ' ------------------- . 1 ___-. 1...........-.-. ...Final Inspecti . -.-. <br /> - .........................D...a..te.. <br /> ......7.....­. <br /> SAN <br /> ­_ <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 V68 Rev. 5M <br />