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UK' <br /> APPLICATION FOR SANITATION PERMIT <br /> ...:.: .:.::: ...................... Permit No. -5.Lz� <br /> • (Complete in Triplicate) <br /> 511!7(R.......... . <br /> Folz_��P:JJ._ ... This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Locel 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 ADDRESS/LOCAT N .. l. Ole' . C / ENSUS TRACT, <br /> ...... . .. ...... <br /> Owner's Name ._Phone <br /> AddressQ� /`-a <br /> City .-�4 �� <br /> Contractor's Name._�a�i *s-� C e lf'� <br /> Licens # Y. .. Phone .......................... <br /> Installation will serve: Residence Apartment House❑ Commercial FIT, <br /> Court � a <br /> Y Motel❑Other <br /> ..... <br /> Number of living'umts:::: ..:_: Number of bedrooms 3::::. <br /> Garbage Grinder .......... Lot Size ::'.�60/�.•3.G "`"°4¢t <br /> tWater Supply: Public System and name ......................................... Private <br /> sr Characterof soil to a depth of 3 feet: Sand D Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ ' <br /> Hardpan❑ Adobe ❑ Fill Material........ -. If ye:,type........................... R< x <br /> t; (Plot pian, showing 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 available within 200 feet, <br /> PACKAGE TREATMENT-�..[ <br /> SEPTIC TANK Size. / .7.�tr.` -�....-:__ Liquid Depth .�. .... <br /> ro .] " <br /> x <br /> a g � •`,�"� Capadty_,. 15.._. Typt���as4t Material �01'tls. :.. No Compartments .... ......... <br /> Distance to nearest: Well Foundation.....t.0 _......:. Prop. Line....:..� <br /> P / <br /> LEACHING LINE.,'s[e1 • No. of Lines _..—Z .:.: Length of each line.: /0O-.. Total Length p" <br /> l <br /> D''Box ._ Type Filter Material __.....Depth rilter Material l tel'.._' ' <br /> Distance i nearest: Well ._ Foundation l 0 r Prop��rty Line �' : <br /> # v <br /> a <br /> : SEEPAGE PIT .Depth :o7`T t Diameter .��3 r� Number .. Rock Filled Yes No ;. <br /> Water Table Depth .............—.4FDRock Size- /...s X <br /> t r <br /> `. Distance to nearest:Well �. Foundation Prop. Line ...r <br /> 3�t ,:r ��,� RHAIR/ADDITION(Prey Sanitation Permit# ..._.... ... ........... Date .................. <br /> `i Septic Tank(Spenf( tRequire ments) .. _ <br /> :... <br /> { v Disposal Field,.{Specify Requirements) ................................................................... ............................................'�� <br /> .... <br /> r{ <br /> 1�r 4 4 <br /> (Draw existing and required addition on reverse side) <br /> I+hsjreby certify that i have prepared this application and that the work will be done in aecerdance with Son_Jeaqutn r <br /> 4 County Ordinances State laws, and Rules and Regulations of the San Joaquin Local Health District.Homs owner or(tten <br /> ,S �} Y sed`agents:ignatuir certifies the following: ' ..� .__ . �__ Y ,; •_ ;��� x� <br /> "I certify that in.the performance ef.thrwork for which this permit s issued, I shall not`en+ptoy any penen h such.man <br /> os'to t»w joct ti-Work s <br /> s omppn:anon laws of California." J , <br /> a <br /> Signed' : O: er- <br /> :. ...... <br /> (ifotherthanowner <br /> k " '.��- "•` � . FOR DEPARTMENT USE ONLY <br /> d APPLICATION ACCEPTED BY:.. ................................` DATE.of ...T..::�Q'T......� .. <br /> r <br /> BUILDING PERMIT'ISSUED:., ..:.:.:... :. : ..:.................. ::DATE. � s <br /> ADDITIONAL COMMENTS ' ;` <br /> ..... _:. ...:_.... .....: ...................... 4 <br /> _... ........................... <br /> ................: <br /> t! Final Inspection by, ... ............................................................... Date :.�' <br /> h' 6 SAN JOAQUIN LOCAL HEALTH DISTRICTg <br /> E.H 9 1 68 Rev 5M r <br /> .a ....x«� <br /> " } "o'3 <br /> X <br /> b <br /> yi <br />