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FOR OFFICE USE: <br /> -. ........ APPLICATION FOR SANITATION PERMIT <br /> (Com Permit No. :77Xr__0tF ; . <br /> plate in Triplicate) <br /> ........ .................­................... This Permit Expires I Year From Date Issued Date'lssuecl <br /> Application is hereby made to the Son Lo�col-,Hedlth_ 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/LOCATION <br /> ./ _;�4�� -.Z! CENSUS TRACT ........... ....... <br /> .......................... ............... <br /> Owner's Nom�ee .....oilk., 12.. <br /> Address ..... .................( -.1.....................................Phone ..................... ......... <br /> ----........ ......-•-----••------....... <br /> ......*.... ............................ City .............__...................... <br /> Contractor's Nome ....../J�P/nop ........ ..............................License Phone OKO�7". Zw------ <br /> Installation will serve: Residence;V Apartment House oCommercial :nTrailer Court 0 <br /> Motel []Other .......................... <br /> Number of living units:... ..... Number of beclroom�s`jJR------Garbage Grinder, Lot Sizelw�..../.....2.1.0............ <br /> Water Supply: Public System and name ------ .....................................Private C3 <br /> Character of soil to a depth of 3 feet.. Sand C] ..Silt 0 Clay C] Peat C1 Sandy Loom ,0 Clay Loom 0 <br /> Hardpan [J Adobe Pd Fill Material ............ If yes,type ....... ....... <br /> fx <br /> (Plot plan, showing size of lot,'Iocation of system in relation to wells, buildings, etc. must be pIa'cedr'_o*Tn-reverse side.) <br /> NEW INSTALLATION- (No septic tank or seepage pi`f/permitted if public sewer is available within 200 feetJ <br /> PACKAGE TREATMENT SEPTIC TANKf J Size....... ......... .............................. Liquid Depth ........................... <br /> Capacity ._-----•--....--••-• Type .................... Material.--------------------- No.. Compartments ....................... <br /> Distance to-nearest.. -Well <br /> .. ... Foundation ........... Prop. Line ............ ....... <br /> LEACHING LINE <br /> No. of Lines ..................... Length of each line----------------- ........ 'I Length ...... .. . <br /> Total .................. 0 <br /> 'D' Box .....I i <br /> Type Filter Material ....................Depth Filter Material,.......... .........7L.I.....'... 0 <br /> Do <br /> Distance to nearest. Well ........... ............. Foundation ..................I..... Pioperty'Line ..........I....... <br /> SEE'P'AGE PIT Depth ........................ Diameter ................ Number ................. _ ------ hack Filled Yes ❑ No <br /> Water Tab!� Depth .................. . <br /> .....— ::.Rock Size ......................... 7. <br /> Distance tonearest: Well._- --------_-_ ___Foundationunclation .................... Proo:-Lifib....................... <br /> ,REPAIR ADDITION(Prev. Sonitation"�Permit ----------- Daite .r)l <br /> m . ............. <br /> Septi' Tank�(Specify Require! ents') 4g,4� <br /> Disposal Field .(Specify Requirements) ........ .............. <br /> .----------------------------------------••---------------- ---- ----------------- ................ <br /> ................... <br /> .............. .................................................. ...................I——................. ...................-...... ------------- <br /> ....................... ............11........................... <br /> (Draw existing existing and required addition-----------------------*----------------------------------- ---------------------- <br /> on reverse side) <br /> I hereby certify that I have prepared'this application and that <br /> the work will-be-done-in-accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Nome owner or licen- <br /> sed agents-signature certifies-the follo: wing: <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 /> ................ ............... ........... <br /> By ........ ...... .. . ........ rt <br /> other than owner) .......... .... .I tie <br /> OR PEP USE ONLY <br /> APPLICATION ACCEPTED <br /> .............------- <br /> BUILDINGPERMIT ISSUED ......... ........... ...... ........... --------------------------------------------------- ......DATE ........ .............................. <br /> ADDITIONAL COMMENTS ................ ....... <br /> .. .......... ........................................:.,-......L.,..T..1.1.,.-..'_........... ...........­­­...... <br /> ..................... ...... .... ............I ..... ........ ....................... --------- ..............------•••.........................I................. .............­1........1. <br /> --­---------­-----I........... ... ................ .... . ........ ........... .....I.. ...... ......I.... .....I..... ............................................... .......­­­................ <br /> - ---------------------------- ....... ...... ... ...... .. ....... ....... .. :...... ....... ...... ............. ..... ...I.........­­............I....... <br /> Final Inspection by. -- -------- ...... ...�/ <br /> ------------ - ----- -- ....... .. . ........ .. . .................Date ...... <br /> �A <br /> SAN JOAQUIN -LOCAL HEA <br /> L ISTRIC CT <br /> E. H.13 24 1.'68 Rev. 5M 7177 -3 <br />