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r <br /> FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> ...............I....,........I—.............. <br /> 4 <br /> (Complete in Triplicate) <br /> ................................................. This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Sa opqui . Local Health District for a permit to construct and install the work herein i <br /> described. This application is m it $) a ce with County Ordinance No. '549 and existing Rules and Regulations: <br /> e. <br /> JOB ADDRESS/LOCATION ......6.`1-.-..�z'4 W-----67 Aj..le ..._._.._.. ...CENSUS TRACT ..It.................... <br /> Owner's Name .............:. .-Phone �s .....------ <br /> Address . ._ S..lo�.. ,.....�aL.�...� tcrC_.!--------- ----- ----------- City ..���r�. ......_... <br /> Contractor's Name --•- ...:Q ... , 't --------- ----------------License # .. ...... Phone .... ......... <br /> Installation will serve: ResidenceXApartment He use�J Commercial []Trailer Court 0 <br /> ,. -- ---_..Motel❑Other--.� <br /> Number of living units:...,,...... Number of bedrooms ..tpo <br /> Garbage Grinder _".�,_..... lot Size _X_7+ ......---- k <br /> Water Supply: Public System and name .._... PLL... k-) ...... Private ' <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> " <br /> HardpanNj Adobe ❑ Fill Material ._- If yes,type ...................... <br /> (Plot plan, showing size of lot, location ofsystemin 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 avoiloble.within 200 feet,) <br /> PACKAGE TREATMENT f I SEPTIC TANK.1 } -4(....... "Liquid Depth <br /> Capacity a s..... Type4ZW. Vie&Material.........:...._...... .No.— Compartments .. --------......J <br /> Distance to nearest: Well .. /. -`_.---. ..... , ` p• .,!5;7 ` ` <br /> �. Foundation .., G9 •.- -.-.- Pra Line 6 <br /> �_.-a._�-.r,..r�.-..,.rte.m - ��.�.-•+ f <br />'E LEACHING LINE [ ] No. of Lines - Length of each line. .. y��.�..::.....,:... Total Length ...`s�+ ................. <br /> Type Filter hllaterial -. /... pth Filte f Material -- ---•.................r ....... <br /> s F <br /> Distance to nearest: Well .- : ---- Foundation /0.......:-.._... Property Line _. .................Z i <br /> js'f <br /> F x SEEPAGE PIT f ) Depth .. .-c -�_.... Diameter; .._12w_. ... Number ......./............. Rock�Filled Yes ,� No C3 ' I <br /> Water Table Depth Rock Size :.1.�__r. <br /> �.....------• <br /> Distance to nearest: Well ., G ---"f --------------Foundation ..........._........ Prop. -Line /15................ i <br />' REPAIR/ADDITION iPrev. Sanitation Permit# ----.--- Date ---------------ry-..--------------1 ' <br /> Septic Tonk,(Specify Requirements) ............... �. .��G.... �y�tJ e '. f '_..: .... <br /> DisposalField (Specify Requirements) ---------------------•------------------ -------- ----------------- --•-- ..........................-...-----------....._..._.... 1 <br /> �. <br /> --------------------------------- ............ ........ ------ ---------------------------------------- <br /> ----------- ........................ ---- ------------------ -- --------- .......... ...----- .. <br /> (Draw existing and required addition on reverse side) j <br /> I� 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin j <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health DistriEt. Hayne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify shat 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 /> BY . .-- -----. .-- -•......... ........... ............--------------............... .Title ..._............ .. .............. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...-,, x _� -.............. ....._........__....... ------. DATE .,?//..J17 ..............._ <br /> BUILDING PERMIT ISSUED ... ................. ...... ....--•--............ ....-•----•...DATE ---------- . ------_----• <br /> ADDITIONAL <br /> ` :.... COMMENTS <br /> TS -......___...... ............................ -----,--�-,-_-- <br /> .- ............. ------------------------ ----------........... ............... <br /> _.....­­--------- I ........................... . ................................................ <br /> ---- <br /> ......... ............... _-------- ............ ..-----..._ . ••........... <br /> ----- ------- <br /> _~.. ................. - --ateFinal Inspection by: ......e--- -----LZ- SAN ...... <br /> JOAQUIN LOCAL;HEALTH DISTRICT , <br /> c u 13 2 ti i.o o_., eu - <br /> 7/7.2 3 LK - <br />