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FICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .......................I';................. <br /> Permit No. ............ <br /> .............................. ....... <br /> {Complete Triplicate).......... . <br />....................•__.--............................_,_ . This.Permit Expires I Year From Date Issued <br /> 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 Ordinance No. 549 and existing Rules and Regulations- <br /> JOB ADD RESSAOCATION'..Z�__, <br /> _01M4_1o..CENSUS, TRACT ------- <br /> Owner's-Name ..............................................................................Phone <br /> Addreii ---- <br /> 5 <br /> ...................•4..........vaty ..................•--••......•••--..... ........ <br /> Contractor's Name X.-Al.. ....... ------•...........................License#0v0.-,-d'a ---- Phone <br /> Installation will serve- Residence[9 Apartment House C3 Commercial railer Court 0 <br /> Motel 0 Other <br /> .... Number of bedrooms ... ... rbage Grinder Lot Size <br /> Number of living units:---,/. _Ga ...... <br /> Water Supply: Public System and name ............................... ...... ...... ................................ <br /> Character of soil to a depth of 3 feet. Sand 0 Slit 0 clay 0 Peat 0 Sandy Loom 0 Clay Loam <br /> Hardpan Adobe 0 Fill Waterlail ........ If yes,type............... ............ <br /> (Plot plan,.sho 'Ing size of lot., 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 avalloble'within 200 feet,} <br /> PACKAGE TREATMENT f ] SEPTIC TANK I Size__-12010...... .. .... Liquid Depth ... <br /> Capacity ` --.. ffiaterlul. <br /> Type 19r...64-lt No. ;ompartnients f <br /> Distance.to nearest. Well ----- ................Foundation .......... Prop. Line 7---- <br /> ........ <br /> LEACHING LINE No. of Lines ....../............... Length of each line......7.��............... Total Length --- - ----••_--- 51 <br /> 'D' Box .../...... Type filter Materl�! .._.ZrA!,-Zepth Filter Material ,2.."/.................................. <br /> Distance to nearest: well Y.___. Foundation ---.1o....._.__.. Property Line ...... ....... <br /> 1E <br /> E 21T Depth .................... Diameter ......... Number ............................ Rock Filled Yes 0 No 0 <br /> "6EE26�2 Wate� Table Depth ...__................I.......................Rock Size ...... .......................... <br /> A Distance to nearest. Well ... 1 4 <br /> ........................*............Foundation .................... Prop. Line ..... ................ <br /> REPAIRADDITION(Prev. Sanitation Permit# ..... .................­­­......---------- Dote ..................................... <br /> SepticTank (Specify Requirements). ..................... ........... ........ ......................... ............................................I.................. <br /> l P., <br /> DisposalField (Specify Requirements) ._....._.•------------------•----..... .... •-------•--......---------------•-•-------• ----------.----------------•--------------- <br /> T--------------------- ....... ---------------------------------.-•-_•-••_-••••--•..__.. .._....... ---------------•------••------•---. ......... ........ ............. .......... <br /> ---------------------------- -------------------------------------------­......... .......................................................... ...... ........................ <br /> JDrow existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work milli be done <br /> In accordance with San,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 ja Ama�' om risation laws of California." <br /> Signed <br /> ....... ... <br /> ------------------------------------- ......................... • <br /> Owner <br /> By ----------------_-------- Title ----_------------ .......... -------- ................. <br /> - ---- ----------- <br /> (If other than -------------------------------------------*--------- <br /> /VOR DEPART EMT USE ONLY <br /> _......... ..... ...... 1..........w-------------- <br /> APPLICATION.ACCEPTED BY ...1 ��� <br /> .. .... DATE ------ <br /> BUILDINGPERMIT ISSUED ---------- ......................•---......._/..................... ...........................DATE ........................................... <br /> ADDITIONAL COMMENTS ............. ............... ............................................ <br /> --------------------------------------1-1-----I——-------------1-1-1-1*------------------------------------------------------*......­*..............*............*.................­................. <br /> -----­----------- --------------------­-- ----- -- <br /> . . -----­­.....................................................1-1------1-...................... ........................... <br /> ---------------------------------I---- - ------ -----­-------- .. ...... ...... ....................................... ------------- <br /> Final Inspection by: ------ . .....X------- ---------------- ... .. ................... ...............I------ 74-------------- <br /> ........... --------------- <br /> EH 13 21; 1=68 Av. 5M <br /> SAN JOAQUI -LOCAL HEALTH DISTRICT 8/74 3M <br />