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FOR OFFICE USE:
<br />APPILICATION FOR SANITATION PERMIT
<br />..: ,
<br />(Completo in Triplicate) Permit Ido.
<br />This permit Expires l Year From bass issued Dote Issued
<br />Y"
<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 complia ce with County Ordinance No. 549 and existing Rules and Regulations:
<br />JOB ADDRESSJLOCAT,,IO�O,/N� ,.......�?.. '.d ...._;....�..�r!,�'° . ��L ............._ ENSUS TRACT .................,.,«�.,..
<br />Owner's Name ......J°-t's,.... .........................._ ..-......__.....:._ _ ...._.. one ........ ................«.....«.,..
<br />CiAddress ...............-..�.. ..1........ ._ .... .............._.. ... ....._._........._..._....__.,.............. ......«..
<br />Contractor's Name ._..._.., _.... ,._ ...,��-��.. .a0�Y�L.icense #���-� ._. Picone __...... .........«.»«.,..
<br />Installation will serve: Residence Apartment House ❑ Commercial QTrailer Court [I
<br />Motel Q Other ........................... .......... ,......
<br />Number of living units ......... . Number of bedrooms Grinder- --... Lot Size ,..tte a-11%Ir ---------
<br />Water Supply, Public System and name ,................................... Private Ar
<br />Character of soil to a depth of 3 feet: Sand 0 Silt (] Clay Q Peat ❑ Sandy Loam 0 Clay Loam
<br />Hardpan Q Adobe [] Fill Materia! .......... __ If yes, type ............................
<br />(Plot plan, showing size of tot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)
<br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) �
<br />PACKAGE TREATMENT . [ I SEPTIC TANK f l Size+ ......................... ....... ....,... , _... Liquid Depth... _........... ....
<br />Capacity ................... Type ............ „.. ill3al.... .................. No. Compartments .,4..............A.,.
<br />Distance to nearest. Well ....................................Foundation ..... ..... _.._.. Prop. Line ... ........
<br />_.,..
<br />LEACHING LINE i ] No. of Lines Length of each line ...... ____ ....... Total Length ...... . «... «_.
<br />'D' BOX ......... , Type Filter Material ....................Depth Filter Material ... ........ .....................
<br />.,�,w«.«...
<br />Distance to nearest, Well ........................ Foundation ...._.................... Property Line .....-....._....._....._
<br />SEEPAGE PIT [ j Depth Diameter ............... Numbw .... ..................... Rock Filled Yes Q No �
<br />Water Table Depth Size ...... .................. ___
<br />Distance to nearest: Well .......... ...... .d...,.. ..... .....a««««..Foundation .................... Prop. Liras ......................
<br />REPAIR/ADDITION (Prev. Sanitation Permit _...,,....... _ ...: ................. date ........... �.-.�......_.«... -)
<br />Septic Tank (Specify Requirements) .................. .. . .........____ ................. —.,,.. __..,._........... ....M
<br />Disposal Field (Specify...
<br />` Requirements) ._..__... ...................... ..................... ,........,«..,,.... „..._., .. .
<br />.,.
<br />(Dr existing and r addltion n reverse side]
<br />I hereby certify that I hays prepay, is application and that the work wIR be dans In accordance with Son Joaquln
<br />County Ordinances, Stats Laws, and Mules and Regulations of the San Joaquin Loral Health District. Hence ower or Hawn -
<br />sed agents signature certifies the following:
<br />"I certify that in the performance of the work for which this permit is Isswd, t shod no employ any poison In such manr*6fr
<br />as to bec subject to Workman's Compensoti n laws of Caalifewnia."•
<br />Signed ._ _......_.,..»....«.._._......_wnett' Title
<br />(!f other than owner`)
<br />FOR D P_ I'MENT USE ONLY
<br />APPLICATION ACCEPTED BY /,",Z ,ri�c.,,4�......,«.......,................ ...... DATE
<br />BUILDING PERMIT ISSUED ........................................... _ ..�........_.......... ... _ ..,...................DATE ...... .... ...........
<br />.... _ .. ..._.,
<br />ADDITIONALCOMMENTS___ .................. ... ............................. __.................... . ,. .__.<:.... .,_.....
<br />.......... ......................... .................. ............. ..... .................... .,,....._««....., ................... _.................... ...._.... _.. ...............................
<br />................ .................................. r F tial Inspection .r� . 4 ..'. �« ......... .... ................ ............4...........
<br />UN JOAQUIN LOCAL HEALTH DISTRICT
<br />E.1 . 9 1 •' d8 ' Rev. SM
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