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FOR OFFICE USE:* LL <br /> ---------------------------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- <br /> (Complete in Triplicate) l - - <br /> ---------------- --------------- -A <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit tolconstruct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ,�jio.N 032-S CAMPO --------E$44k.'.--CENSUS TRACT ------ ---------------- - <br /> JOB ADDRESS/LOci _/0 11.1----.�.--".--.---�,--.�--�-I,E---- - <br /> Owner's Name <br /> -------J--------Gi- -------------------------•-k-------------Phone ------------------------------------ <br /> Ck. --------------------- ---------- ---------------- <br /> Address --------------- 4 y _J15's'O, <br /> ------- -------------- t'<'l <br /> Contractor's Name _'hwAmp---------------------------------------------- ------------------License 0 _-1/1----------------- Phone -------------------•------•--- r <br /> Installation <br /> .---------------------------- <br /> Installation will serve: —We?i-cieii-ce—?';��pa—rfffie—Kt-H"6!Ts-e,E] Commercial :E]Trai I!er Court <br /> ,N <br /> Motel []Other ----------- -------------------- ----------- <br /> - -------- Lot Size ... --- - -------- <br /> Number of living units:____(------_ Number of bedrooms :��4' ._Garba_ge Grinder No <br /> Water Supply: Public System and name ----------------- --------- -------------------- i---- -------------------------------------Private <br /> --------------i _,11 <br /> Character of soil to aldepth of 3 feet. Sand 0" Silt E] Clay F] Pp��[] Sandy �oam 510' Clay Loom F-1 <br /> HaZrdpbnj .AdobeD Fill Material ------------ Ifyeg, type --=------------------------ <br /> _ - <br /> ]Piot plan, showing size of lot, loc6ion oiNsystem in relation to wells lbuildings, emust/be placed on reverse side.] <br /> seep NEW INSTALLATION: (No sepWtank or ,ge pit permitted if publ' ft.,il sewer is available within 200 feet,}' <br /> NA!_>T-#W?:�------------------------------------------------ Liquid Depth --------------------- <br /> PACKAGE TREATME'NT SEPTIC TANK <br /> Capqcity -------------------- Type ------- Materiai'f------------1------- No. Compdrtmenft ------ ------------- <br /> Dist4nce to nearest: Well-.,.._..—------Foundation ---------------------- Prop. UM6 ...................... <br /> LEACHING LINE No! of Lines ----------------- Length of each line------------- --------- Total Length <br /> f C-- d <br /> I—Xt SriA Box ------------ Type Filter Material --------------!------Depth Filter Material --------------------I--------------------- <br /> Distance to nearest: Well ------------ Foun'dation- ----------- --- -------- Property Line --------- <br /> ;;,---------4-0 -. .. I /---------- <br /> SEEPAGE PIT Depth ---- ----- Diameter <br /> !- 7-—- - 41-rV---- NuImber ---- <br /> -- ------ Rock Filled Yes No 0 <br /> Watery Table 6epth, - - Z ------- Rock Size---- - <br /> ---- -------------I- ............... <br /> Diitance to ' _..___Fouhdation 149----------- Prop Line <br /> REPAIR/ADDITION(Prev Sanitation Perrnit# ---------------------------------------- Date ------- ------------------------- <br /> y Requirements) --------------------------------------------------- <br /> Septic Tank (Speci,� ------------ <br /> ------------------- ---------------------------------- ----- <br /> ---------------------------------------- <br /> Disposal Field {Specify 'Requirements), I�UAAV K <br /> pi <br /> --------------------------------- ---------- ---------------------------------------------------------------------------------------- <br /> ------ ----------- ---------------------------------------:--------- <br /> ------------------------------- - ---------------------------------------------- ---- -------------------- ------------------I------------- --- --------------------------------------------------------- <br /> ition ort <br /> T�erse-side),, <br /> (Draw existingand reqqire4 add i <br /> 1,hereby certify that I have prepared this application and that the work will ill be :4on'e in accordance with Son Joaquin <br /> County Ordinances' Llitaie Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature 6rfifies the following: <br /> preifdirr�ance of the'work-for which this permit is issued <br /> "I certify that in the I shall nqVemploy any person in such manner <br /> as to become <br /> b"ect,t W rkm <br /> q 'S Compensation"laws of California." <br /> Signed ---��_ A - -.- Owner. <br /> 7 ,w <br /> By ---------- --------- --------------- -------------------------------------------------- <br /> Title --------------- -------------------------------------------- <br /> (If other' than owner] <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----------t---r <br /> AN------ ------------------------------------------------- ------------------ DATE --------------- <br /> --DATE....... <br /> BUILD­ING-PERMIT­ISSUED�----—------------------------- <br /> ------------------------------- --- -- ---- -- ------ -- ------ -------------- <br /> ADDITIONAL COMMENTS ---------- ------------------- ---- -------------------- <br /> --- ------------- -------------------------------------------------------- <br /> --------- ----------------------- <br /> - <br /> ---------- ---- ------------------- -------- <br /> ------------------------------------- ----- ---------------------- <br /> --`=------------------------------- <br /> -------------------------------------------------------- -- ------------ ------ --- - ----- --- ------------------------------- <br /> Final Ins ------ -- ---------------------Date ------ ----------- <br /> - -- ----j2-197_7 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />