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OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> . (Cantplete In Triplicate) A';3 Permit N0 <br /> . <br /> Dote Issued <br /> ......................................................... This Permit Expires 1 Year From Date Issued , <br /> Application is here4iy made to the San,daaqutn Lacaf Nealtli bistrict``fo�a-1 ermlt'�eo=construct. and.install the work herein. , <br /> described.WE -il—., <br /> ation-is_rnade-in.compl.iance-with County:Ordinance..No.-549--and-oxisting-Rules and Regulatlonst <br /> 21 1 <br /> JOB ADD '' .. . .. ........ .............. <br /> .CENSUS TRAC <br /> { Owner's Nome -�-�--- ..... . .. . ............:. .................. .......Phone .. .. <br /> Address .7..L7__._ ...... <br /> Contractor's.Name ..L.lr/A... = ..............License r C ��. _ Phone r t... <br /> -I <br /> j installation will serves s ansa 814.1-louse 0 Commercial C]Traller Court" <br /> Motel El Other %--, .. It................................. <br /> �' living •Number of _.__........ Number of bedroomi ' <br /> � units- �...�..Garbage Grinder ---••-------:Lot Size .�.......------....................... <br /> Water Supply: Public System and name ........................... ----•-----._.._..._- ....................................................Private <br /> .'. <br /> r Character of soil to a depth of 3 feet: Sand❑ Silt[j --Clay Q Peat p Sandy Loam ❑ lay Loam 0 <br /> � Hardpan❑ Adoi;e G( flit Malarial ............if yes,type . <br /> 0 <br /> )Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be .placed on reverseslde.l <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ] SEPTIC TAN Size.... �.... ... Liquid Depth <br /> CapacityIT _ i ,21......... <br /> JryRe - Material...................... No. Compartments <br /> i :. F <br /> Distance to nearest: Well .._,fi Q.t_._...... -foundation J ... Prop- Line . -. <br /> f, ......_.... .. ......_.. <br /> LEACHING LINE ) No. of Lines - ►...---•--.------.. ---- <br /> Lei <br /> of each line.:---- -..--.-.' Total Length .. .:. 2Q. <br /> 'D' Box J Type filter Material ..Depth filter Material. ��. .... <br /> r - . Distance to nearest: Well . �__ aundation .A.............. Property Lind N� .......... .. <br /> SEEPAGE PIT Depth .c-! _-----•-•--. Diameter s ......_. Number ....�......::............ Rock Filled Yea4 No Q <br /> Wats► Table Depth _ _. <br /> 60 <br /> Rock Size <br /> I J. Distance to nearest: Well .foundation . Prop. Line 77 <br /> REPAIR/ADbITION(Prev.—Sanitation Permitg <br /> .........---•. . . .... ......•-•-•----•---. Date ---- ---- •--.... ----I <br />(. Septic Tank (Spec5fy--Requirements) -. t....__. .�: . .. .......................•___._.._ ........................ <br /> Disposal Fieta j`tSpecifjr_Requirernen_t4 �' - <br /> ....................................................... r_... . ±: ._•---•- ... .......__......._......_....•••................•.......----•--••--••....._................ ....... <br /> ....................... ••• ................ ......-..............._.....a........ -'==-__ - , <br /> (Draw existing aria required addition ori reverse side) - � -,i <br />{ 1 hereby certlfy that I have prepared this application and that the work'will ba done In accordance with San:Joaquin <br /> I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hem* owner'Or liven. <br /> sect agents.sig nature certifies the following: <br /> "I certify hof in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner <br /> ' as to become subject toorkma 's Compensation lows of California." i <br /> Signed .... <br /> ... <br /> ......... <br /> ............................................. Owner -. . <br /> By . Title A <br /> ........... ...........................••---••••.._........... ........................... ...... r <br /> (!#other than owner) <br /> FOR DiEPARTMENT. USE ONLY <br /> APPLICATION ACCEPTED BY...•••........._... fA............................................... <br /> ...................:...:DATE ....� � • �� <br /> BUILDING PERMIT ISSUED ............................... ................................... DATE ...... :......:.:: -..::...:.. ... <br /> ............. <br /> ADDITIONALCOMMENTS .......... ......................._._..-•---............_.............._......._.".............---..............._.......... <br /> ............... ...... ................"_ -.._. .......-..... .........................__........ . <br /> ................. ........... ..................... <br /> ...... .................. <br /> .......... <br /> ............... <br /> ._._............ <br /> :..._ . . l� ... y <br /> Final Inspection by: -'�O`..:.�._.. ..Date F <br /> --_.... <br /> EH 33 24 1.-60 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />