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=OFFICE <br /> ppptrICATION FOR SANITATION PERMIT <br /> Permit No. - <br /> (Complete in Triplicate) <br /> Date issued � -This Permit Expires 1 Year From Date Issue <br /> alth <br /> rict for a <br /> ct and <br /> l the work <br /> Application is hereby made to the San Joaquin Lo <br /> compliancecwi hal eCounDty#Ordinance permit <br /> and existing Rules tand Regulations- <br /> ------ <br /> egulations herein <br /> described. This'.application is ma <br /> / ----CENSUS TRACT -------------- ------ <br /> JOB ADDRESS LOCATION ---fes�`�---------- � = Phone ----------------------------- <br /> ----------------------------- <br /> �- -, °a- <br /> Owner's Name ---- i-G- <br /> Address-----------------6&- _�-------------------------------------------------- r <br /> 1 ILC _ License # , �__ Phone _ y. <br /> -�1---��""--- -It*Contractor s Name _. ! „ _.__ x _ _ _ <br /> t <br /> installation will, serve: Residence [�Apartment"1'louse�❑ Commercial'❑Trailer Court <br /> Motel ❑ Other -------------------------------------------- <br /> ) t � _._Garbo eGrinder -------- --- Lot Size _.��----X--�°��---------•-----• '. <br /> Number of living units:--/----- Number of bedrooms --- ----- -g <br /> i -Private <br /> Water Supply: Public System and name ---------- <br /> I <br /> y' i Sand Loam, Clay Loam <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Y <br /> � � �••---�-•--�--r-�Hardpan.❑_.�.:Adobe"❑'"•Fill lNate`rial --�-t WC-y-01 --- ----------------- -- <br /> --- <br /> system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> (Pl'ot plan, showing size of lot, ,location of Y <br /> N # p it ermined if public sewer is available within 200 feet,) <br /> NEW INSTALLATION: (No septic tank or seepage p' p <br /> PACKAGE TREATMENT f ] t SEPTIC TANK'[ ] Size------------------------ Liquid Depth --------------- <br /> F 1 Material---------------------- No.€ Compartments ---------------- <br /> Ca <br /> Capacity. Type ------------------ <br />{ p Y - Pro Line ----------------------- <br /> Distance <br /> ------------=-------- <br /> Dist�nce; to nearest: Wel! ___--._-----------------------------Foundation ____-___----�-_"--- p• <br /> t <br /> - - - ----- Total Length : ----•----,-•-----------•-- V1 <br /> ---------- Length of each line------------------ - <br /> LEACHING LINE [ ] No of lines -"----- ----- Depth Filter Material <br /> t p ------------ <br /> I I 'D' Sox �---��-"" --- Type Filter Material -------------------- <br /> �DistaI ce to nearest: Well _------------------ <br /> Foundation Property Line --------- --- --------- <br /> t �= <br /> _ ---------_-.-- <br /> Number._. : <br /> -------------------'-; <br /> Rock Filled Yes No E <br /> Diameter <br /> Depth SEEPAGE PIT L 1 11 ( - Y Rock Size ------------ <br /> i Water Table Depth ------------ <br /> s <br /> {.Distance,to nearest: Well <br /> 411, 11 Foundation ------------I------- Prop. Line ----------------•-- <br /> DITION <br /> (Prev. - k <br /> REPAIR�AD'� ) i Date ----=------------ - --- } <br /> . Sanitation Pei mit# -------•�-------- - •, <br /> Septic Tank (Specify Requirements) ----- -------------- "----------- - <br /> j ) .� A 1iv 1 '-----------a----�s'�� �� <br /> Disposaly.Field (Specify Req rements) -------� <br /> I R <br /> _.=_ == <br /> -------------------- <br /> - -------------- „ <br /> �..� z-- <br /> - ----------------------- ---- <br /> - ------- ��,w : <., <br /> t t 1w (Draw existing End required addition on reverse side) <br /> 1 <br /> I hereby certify that l ham prepared this appiicah San Joaquin <br /> t'lon aQnsto�the San Joaquin4Local Health District.'ccorHometowner or 1�en- <br /> County Ordinances, State)Laws, arid, <br /> and Regu T <br /> f sed agents signature certifies the following: ' i <br /> "I certify that in the erformance of the work for which this erihit is issued, I shall not employ any person in such manner <br /> y p p .� <br /> as to become subject to Workman.'srCompensati.on,Taws of.California." <br /> Sig 9,_,_. �- `�� ti == --------- ------ caner <br /> O r <br /> rVe F <br /> iy -Title -- --- ----- ------- -------- ---- -- ------- ------ ------- --- <br /> ------------------- -- ------- <br /> (if <br /> ----'(If other than owner) _ <br /> F "DEPART NT USE' ONLY'" <br /> DATE ' -7---------------- <br /> APPLICATION ACCEPTED BY -_-- <br /> ------------------------ <br /> -- --- ------------ -------------- ---------------- -------- -------- --------DATE ----- -------------- --------------- ---- <br /> BUILDINGPERMIT ISSUED ----------------------------------- -- ---------------------------------------------------------- ---------------------------- <br /> ADDITIONAL COMMENTS ------------- ------------------------------------------- ----- - <br /> ----- <br /> - <br /> --- -- --- --- --- <br /> ------------ <br /> --------------------------------------------- <br /> - - ----- - -- --- "7-- <br /> -&------ --- <br /> Final Inspection by: -- ------ ---- - Date <br /> SAN JOA IN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6B Rev. 5M <br />