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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ,-- r4 (Complete in Triplicate) Permit No-749-Af <br /> .............................................. <br /> .............. This Permit Expires I Year From Data Issued Date Issued&t-!Z�:?o <br /> Application is hereby mode 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/LOCA N 40, k <br /> ...CENSUS TRACT .......................... <br /> Owner's Nome �----••---• <br /> hone .................................. <br /> ........... <br /> Address W., city . ................iJ <br /> Contractor's Nome ... License Phone <br /> Installation will serve: Residence <br /> ,WApartment Housefj Com Trailer Court <br /> Motel f7 Other ....... ....... <br /> Number of living units:.. .I.... Number of bedroornsi...s2....Garbage' Grinder' .11,-- ----. tot Size ......z9,1e,,ta4j­­1 <br /> Water Supply: Public System and name .... ............. ....... <br /> ...... ........ .............PrivateX <br /> Character of soil to a depth of 3 feet: Sand E] Silt'F] Clay ❑ Peat f7 Sandy Loom X Cloy Loom 0 <br /> Hardpan 0 Adobe'[] Fill Material If yes,type......... <br /> (Plot plan, showing size of lot,-location of system i; relation to wells, buildings, etc. must be placed on reverse side.) <br /> I I <br /> NEW INSTALLATION: (Ni.septic tank or seepage pit permitted if put blic sewer is available within 200 feetj <br /> PACKAGE TREATMENT f SEPTIC TANK I Size.-_...._1..__..__. ................... Liquid Depth ..................... <br /> Capacity Type <br /> .......... No. Compartments .__.-_-_-.......M,». <br /> Mitanceto nearest: Well ................._.-Foundation ............. ........ Prop. Line ................. .. <br /> LEACHING LINE No. of 'Lines .......... Length of each aline..._..._,._...... ........ Total Length ........„.....-_..._...Ar <br /> 'D'. Box ............. Type Filter Material ...»......,A .Depth Filter'Moterial .......................................... <br /> Distance to'lnearest: Weil`--...j..._ <br /> ....___.... Foundation Property Line ........................ <br /> a ' ;7 <br /> SEEPAGE PIT Depth .,�..........._... Diameter Cnn Number t............-.....—Rock Filled 'Yes*O'No mit <br /> Water Table Depth .......................... <br /> I ....................Rock Size.............................. r17 <br /> Distance to nearest: Well 1 1 - "I-_..­_ . <br /> -Foundation.........I......... Prop. Una ...... ........ <br /> .................. ...... Date .........._.......... <br /> REPAIR/ADDITtON(Prev. SAnitation,Permit.#........ <br /> Septic Tank (Specify Requirements) ............. 4— <br /> .......... <br /> ............ <br /> Disposal Field (Specify Requirements) 4;4*ZA.771��'__ ........... t..>Z�...... <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 ac;";* with Son- Joaquin <br /> County Ordinances, State Laws, tend' Rules and Regulations of the Son Joaquin Local Health District. 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 b at bi t ark It's Compensation"laws of California.— <br /> Signed -.,, . e , , %� <br /> M4" ;. <br /> ­ "VL4.44 I.-, - )�" .... ............... Owner <br /> By ........ ........ Ajjiv�wp <br /> • <br /> Title ......................................................... <br /> (If other the'n owner) T­ <br /> FOR DEPARTMENT USE ONLY <br /> .DEPARTMENT <br /> APPLICATION <br /> .......................... -7 <br /> APP71CLICATION <br /> ACCEPTED 8 ........____ DATE <br /> BUILDING PERMIT ISSUED .............. <br /> ........ ..................... ............................DATE ............................ ............ <br /> ADDITIONAL COMMENTS................... ......... ......... <br /> ................................. ...................... .............. ..... ........... .................................................................. ....................... <br /> Final lnspectian bye . <br /> ........................ ........ .. ................................I..............................•........................... <br /> ................ <br /> --------------­_*­_'­---------------­ ...........//S;- <br /> ......................................-_....._Date .__.._......_..l._.._-..•..._..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 114:b8 Rev. 5M <br />