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FOR OFFICE USE: <br /> _ APPLICATION FOR SANITATION PERMIT mss-, 8 <br /> ............ .......... ......--- ......I....... Permit No. ........... i <br /> (Complete in Triplicate) ��••-�•--� f <br /> t <br /> ............. this Permit Expires 1 Year From Date Issued Date issued ,/6 5?7-Z-5 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is mode i compliance ith County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .CE�C <br /> _ CENSUS TRAC <br /> Owner's Nome ..f:.. ... ....-.. .V�" tfl ._r. ,....------• --------- -----`-_..-. - Phone ..........._:..._.__._..... <br /> �.5 . ... ..... . . c . <br /> Address --- i. Y ............. <br /> Contractor's Name _.V .�- h�1�`�C;. --•----- �� _-J.D.e..-License # .. :.. Phone __.. <br /> Installation will serve: ResidenceApartment Houl a,Q Commercial OTrailer Court C] <br /> Motel Other . . <br /> Number of living units:., Number of bedrooms ._._----_.-Garbage Grinder .. Lot Size .. •--•• <br /> Water Supply: Public System and name ------------------------------ ---------- - --------------------------------------- Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay ❑ Sandy Loam, Clay Loam <br /> �-� <br /> --Hardpan ....... <br /> Q' Fill Material .........._:. If yes,type •..................... <br /> f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) °Q <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] Size.-------------------------....................... Liquid Depth .................. ...... <br /> Capacity .i ��_.. Type --------•----------. Material.............. ...... No., Compartments <br /> Distance to nearest: Well -.. - .............---------Foundation ..._- -•..._.. ....... <br /> Prop. Line ..................... <br /> r Total Length .� ---------- <br /> 'D' <br /> .._ <br /> �� Len .._ .^.., --.... ' <br /> LEACHING LINE Do.Box Lines T Length of each line <br /> Filter v � <br /> Type Filter Material ............... . <br /> - r Material <br /> Distance to ne rest: Well s �..... A Foundation �......_.. Property Line ."�._ . <br /> . <br /> P_ <br /> --- <br /> l SEEPAGE PIT [ } Depth r- Diameter ................ Number Rock Filled Yes Na 0,- ...-- - -• = � H <br /> Water—Tab a Depth De --------------Rock Size --------- <br /> Py ............ <br /> Distance to nearest: Well ---/(�. ........................._Foundation ............:...... Prop. Line ......... •---:..... <br /> REPAIR/ADDITION IPrev. Sanitation Permit# ........ -_................................. Date ---------._..._..----------_----- <br /> Septic Tank (specify Requirements) ..... .......--------------.--- - - <br /> 4 <br /> Disposal Field (Specify Requirements) _____________ _ <br /> ------------------- ------- -•------ .-- - ......... ------------- -----------------------... ............. ................................. ...... <br /> ... ..a. ...._.. - __.. ..- ._ <br /> --------------- <br /> c <br /> (Draw existing and required addition on reverse side) M <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with, San,Joaquin <br /> -County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen• j <br /> i .'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 parson,in' such manner"' „ <br /> ,as to bec a sub' t t W rk n's Compensatia ws,f Vornia." <br /> � �,. � Owner <br /> Signed .:.. ...... ... ----- <br /> r <br /> By ---------------- Title . ,�_...._...- . ... ........_..... . .. <br /> (If other than owner) ? <br /> i FOR bEPARt SE O Y l <br /> A`'PLICATEON ACCEPTED 13Y ......... --- DATE ... . . .--•---- ----.._,._-------------- <br /> BUILDING PERMIT ISSUED .... ........ . . ...... ... ..... .... . ..........._..DATE .---••----- .......: . <br /> ADDITIONAL COMMENTS ...... -•---------------------- ------- ---------------------------------- ------ <br /> a --------------- - ---•------ ......I—--------- - -I- . -....................................._.._..._.................... ...... ........... ............... <br /> -------------------- --------------- :._.....,... ......_ -} <br /> Final Inspection by: . � ............ ......: - D 3.I .../- <br /> i - I <br /> ,S .SA OAQ IN LOCAL HE LT.H, STRI <br />