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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ............. ...•--........----....- <br /> Permit No. <br /> (Complete In Triplicate) <br /> Date issued 5, <br /> ................. <br /> ........................................... This Permit Expires I Year from Date Issued <br /> .......................... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit <br /> mit to construct and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and <br /> Regulotions. <br /> JOB ADDRESS LOCATION I .......N WCENSUS TRACT ........................V -7 ... . .... ... <br /> Owner's Name .------- ...... --------------Phone ------ ....... _----_-_------- - <br /> Address ............................................................................................... city .................................................------ ........... <br /> Contractor's Name JA7�-5......'.5-0 ---- --- <br /> , X3- Phone .-31Z�J= 2? __ <br /> Installation will serve- Residence aApartment House 0 Commercial OTraller Court 0 <br /> Motel n Other.............. .............................. <br /> Number of living units -..L.... Number of bedrooms .......Garbage Grinder A10_Lot Size ................... <br /> Water Supply: Public System and name ............................I...... ........... ...........................................................Private <br /> Character of soil to adepth of 3 feet: Sando Silto ClayEl Peat[] Sandy Loam o Clay Loam O <br /> Hardpan 0 Adobe-K Fill Material ........rZO yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relatic'n'-to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANKS, <br /> Size.. ...... Liquid Depth .............(A <br /> Y- <br /> Capacity 1;141P6V-. Type/9V45-V--Material4�-V�-e/4-Poa�-No. Compartments ...........�p <br /> Distance to nearest. Well ------ . .......................Foundation Jez <br /> . ... Prop. Line _47.............. . <br /> LEACHING LINE No. of Lines ......R............ Length of each line.......957.-"..-...... Total Length <br /> V Box Type Filter Material Aoi9t'.A�...Depth Filter Material .../!?'. .................... <br /> .P� <br /> Distance to nearest: Well .-_Po............. Foundation .. .........I...... Property Line J::......... <br /> SEEPAGE PIT -------- Diameter --- Number ...... ...... Rock Filled Yeses' No ip <br /> _�,J Depth .32. <br /> Ar <br /> Water Table Depth ........................-...Rock Size ......... <br /> Distance to nearest- Well ............. ..........Foundation _1-..!............ Prop. Line ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ----------------------------------- Date ...... ...........................4 <br /> Septic Tank (Specify Requirements) ...... ............ ........... ................................ -----------•----------•............--•---.....--..._...._.... <br /> DisposalField (Specify Requirements) ----------------- ................................................................................................ ................... <br /> ---------------------------------- ............................................................................................................................... ....................................... <br /> -------------------------------------•------ ------ ----­----------.- ......_.I...... ..............................................................­....... <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 Heal&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 .. ------- <br /> Jitle ....4-2,0M.MIZ�----- /?................... <br /> (14­4;�_ Pt�an_o�ner)*_�'___ -le- -- --------------------- <br /> FOlt Q%KARTM!W USE ONLY <br /> APPLICATION ACCEPTED BY <br /> DATE <br /> BUILDING PERMIT ISSUED ..... <br /> ------------------ ...... ... ....................................... .........DATE ...... . <br /> ADDITIONALCOMMENTS ............. ... ------------------­I................................................ ............. <br /> ------------ -------------------------__........*.----------- -------- ----- .......................................................... .................................................. <br /> ...........­­------_----------------- --- ---------- ----------...--•---.......-..---•------------------r----------1-1--------------­--------- <br /> ­-------------------------­ -------- -- .... .. ..... ........ ------------------------------------------------------------ ?;i­ <br /> final Inspection by: ---- -- - ...............................................•-.....Date //�" � , <br /> r------------- <br /> EH 13 2h 1-6 8 4v. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />