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rwK wrrmz mr: <br /> ....................................................... APPWCATION FOR SANITATION PERMIT <br /> (Complete In Triplicate) Permit No. .... ....� <br /> L..........•...... •N..` ........................................................................._ This Permit Explres 1 Year Fram erhlssued Date Issued <br /> Application to hereby made to the Son Joaquin Local Health D�I f ict-for`}a permit to construct and Install the work herein <br /> described. This application;ls made <br /> /IIn-compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATIO 1.. "�- -...�.......r.................................................CENSUS TRACT ...... <br /> Owner': Itope ... . .. !? . <br /> .. Phone . . ................... <br /> Address ..�.�'..�{ � .. -....... <br /> Contractor's Name . �./L �6`�f ...............City ._. ....�........ ...................................:... <br /> •--•----..:. -- ........ ..................License# .: <br /> �.. Phone �_.�:... .. <br /> Installation will serve Residencel%Apartment Housefl Commercial OTraller Court - <br /> Motel 0 Other <br /> Number of living units:...'_ ...... Number of bedrooms _ ...._.Garbage Grinder ............ Lot Size �f s .. Z� <br /> Water Supply: Public System and name ............................_...._.__................_. ...__.. -.._......._........... <br /> Character of soil to a depth of 3 fest: Sand❑ - Silt[) -'.Clay�0_Peat l]•-.-Sandy_Loam_p_Clay Loam Q <br /> Hardpan❑ Adobe Fill Material ............If yet type............... ............ , <br /> t <br /> IPiot plan, showing :tie of lot, location of system In relation to wells, buildings, etc. must be plated an reverse aide.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet _ <br /> PACKAGE TREATMENT 13 SEPTIC TAN b1ze..•'` <br /> _ """" �.�`��. Liquid Depth ..,r.� 4� <br /> Capacity,j ..._.._. Type . ..... Material...t��-�`T�! No. Compartments ....�..... ... <br /> Distance to nearest. Well .. .Foundation /4 ��— <br /> i <br />' •---•--• _...�......._ .. -•................. Prop. Line .�...........---• <br /> LEACHING LINE No. of Linea ...... _..--•----•- Length o each fne....:___ d F �? <br /> � � .. .... Tota{ Leng#h ........�.................. <br /> 'D' Box .......L,—Type�Fi{ter-Materla{ Depth Filter Material <br /> f 'rl- f <br /> 40 <br /> Distance-b nearest: Well ..... '.. Foundation _ PropertyLin - .... <br /> •�.. ....... <br /> SEEPAGE'PIT '. Depth ..--. �_.._. Diame#erNumber .---- -�-- f Rock ! .. ......... <br /> — <br /> SEEPAGE PIT .. ....... Filled Yes No <br /> ,Water Table_Depth,_:....................... .f. ._............. ak size ' .........Dis#ante to nearest: Well _...... undatio r a Line .� ' <br /> - „� ............:.......Fo n° ........... Prop- L - ........ <br /> REPAIR/ADDITION(Prev. Sanitatio.Pa`'rmlt# ................ .............. <br /> Septic•,Tank')Specify lit qui a entsf. ' .. --- ... ........... ...... . - _ .........._................ f <br /> Disposal f=ield ISliecify Requirements) ..................................... .............�..-_.... ..........- r <br /> ....`........................•.....---•......_ f__........... .. .... ..., ..........................�.................._....... I' <br /> .. ' ... :... f ......................... '""*'•w...-S�.. ... .............. .............1.._.. ..t ....... ......... <br /> y certify <br /> .................................._...........__.............................................:............._._.:.._........... <br /> _ (Draw ex <br /> JD required addition ori reverse side) - -� <br /> I here{: cern that I h prepared this application and that the work will ba done In accordance with Son Joaquin <br /> twaynty Ordinances, State Laws, and Rules and Regulation: of the San Joaquin Local Health District. Homo.oritnet or licen- <br /> sed agents signature certifies the following: <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 . ...4atheri <br /> •. ` .Owner �, '-, , <br /> By ........ ...... ----.......7itle _..._..��... ................................................ } <br /> wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... •._.........;:.. ... ........ ... <br /> DATE ._. ...- .2.:. .� .-: <br /> BUILDING PERMIT ISSUED ..................................................... ............ .................. ..DATE .................. <br /> ADDITIONAL COMMENTS ......... g <br /> ...........::::::::::::::::::: ::::::: _. : : :: ::: = .. .,�::::.................................. ..::::::.........::......::::::.. .............. <br /> ...._._. .................................................................... ------.........--•- <br /> v --------- ------ -- :. ✓ <br /> .-.._....---••-•-•--•........................ ..._...... ..... <br /> Final Inspection-6l SAN !OA[�UIN L Date <br /> I�{ 1 <br /> 3 2 by; .....................�_.l._. �_ :... .__._ OCAi� HEALTH DISTRICT ..� .:.. .: .......... <br /> S/7L 3N <br />