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MR OFF CE USE: , . �,;PLICATION FOR SANITATION PER!-4/11 .4 Permit No: 0467_ <br /> (complete in Triplicate) <br /> ?��k .....------'r._.-------- ..........I Dote Issued .?707-0 <br /> nThis 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 herein <br /> described. This application is made in compliance with County Ord,/', n * No- 549 and existing Rules and Regulations: <br /> e 9 -----CENSUS TRACT --------------_ <br /> .................... <br /> JOB ADDRESS/LOCAT Phone ------- <br /> owner's Name ...... ............ ---­­---------- ------------------- ------_------------------- <br /> . .......... <br /> Address .... ......... ...... 7 .......City -...........I.,-------------------------------------------­------------- <br /> ---------------- <br /> ........Lice <br /> Contractor's Name ....... rise# <br /> installation will serve: Residence[Apartment House 0 Commercial oTraller Court (I <br /> Motel []other-------------------------------------------- <br /> ._..Garbage Grinder,4"..- Lot Size ............... <br /> Number of living units:_....._ Number of bedrooms <br /> Water Supply: public Systern1jand name ------ ---------------------__........................... ----------------------------------- <br /> Privateer <br /> Characher of soil too depth of 3 feet: Sand SiltO Clayo OeatE] Sandy Loam-0 day Loam O <br /> Hardpan E) 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 tanklor seepage pit permitted if public sewer is available within 200 feet.) <br /> PACKAGE TREATMENT f SEPTIC TANK[ Size..........................A+ -------------•--- Liquid Depth ........................... <br /> Material...................... No. Compartments -------­-------- <br /> Capacity ........... Type ............... <br /> Dist',ance to nearest: Well ........................... --------Foundation -----------_-------- Prop. Line .............Z_....... . <br /> LEACHING LINE t�d of Lines _----_--------------- Length of each line---------------------------- Total Length ............. ------------- <br /> 'D'Cox ............ Type Filter Material .._Depth Filter Material ------------------------------------------- <br /> I --------------------- Property Line ........................ <br /> Distance to nearest-. Well ........................ Foundation ... <br /> i I ------ Rock Filled Yes [I No (3 <br /> SEEPAGE PIT Deii:ffi .................... Diameter ................ Number --------------_------ I" <br /> i -Rock Size ------------------------------- <br /> Water Table Depth .......:_­.........................I....... <br /> -Line ------------ <br /> Distance to nearest: Well ----- ----------------------------__.-_.Foundation ........... ......... Prop. <br /> Sanitation itation permit# ...................................-------- Date --------- --------------------d <br /> RffAIR/ADDITION(Prev. nf <br /> ........._-•----------- -- <br /> Septic Tank (Specify Requ _-----irements) --_------- - —----------------- <br /> Disposal Field (Specify Requirements) ........,7 AeAr�.APNVA..... <br /> V­ .................................... <br /> ------------------------------------ -• -------------- -------- ---------------1­1...........­1......................................... <br /> .............................I--------------t.................................................... -------.................._...--•---......•. --------- ---------------------------------------------- <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 aamdence with Son Joaquin <br /> County Ordinances, State Lbws, and Rules and Regulationsof the Son Joaquin Local Health District.Homo owner-or New <br /> sod agents signature cordflis the following: i <br /> "I certify time in the perForlanoce 4YF the work for which this permit is issued, I shall not employ any person in such mariner <br /> as.to become subject to W man's Compensation laws of California." <br /> Signed --•--------------------•------A-------%-- ------------- ......... Owner <br /> e ............ ................................ ........................ <br /> .. . ....... <br /> BY -------------------------------------- -- ­-­ v 04 .......... Titl <br /> I <br /> (if other thanT 7j <br /> 10 g!LAINTMENT USE ONLY <br /> .............. ...... ------ -------------- <br /> APPLICATION ACCEPTED ................................ .. DATE <br /> BUILDING PERMIT ISSUED -- - -- --- ---- ----------------------- ....................................DATE -------------------------•-•-•-•••------ <br /> ......-- --- <br /> ADDITIONAL COMME T ----------••--------------•--............................ <br /> .... . .... ........ . ................................I........I..... --------------I....................................... <br /> . .. .............-------••-••.....-•--••------•. ..----------:--------------•------ <br /> ......... <br /> P .............. .r- ----- --- - ---------------- ------------------------------------------------ --------- <br /> .................I.......I...... .?, <br /> ­­---------- ............ -- ------- - - --- --------- .....................I--­-----------------I............. ..................... <br /> ....... .... ......Date <br /> Finalinspection by- --------- -----------------------•----•----.............................. <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'G8 Rev. 5M. A- <br />