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FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> ..------------- ----------------------I.._......_.I----- } Permit No. .7. .'.S3 v <br /> r (Complete In Triplicatel <br /> -----------. ........................................... This Permit Expires 1 Your From Date Issued <br /> Date Issued .6.. �! :........ ; <br /> II <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 made in compliance with County Ordinance No. 549, and existing Rules and Regulatlonsr <br /> 's <br /> JOB ADDRESS/LOCATION .-/g, x/..-C...tSJfr.l Z...,ioeO7 4,,C prix ,TSr##<Xb...........CENSUS TRACT <br /> Owner's Name ... . ....................Phone . ---•----•- <br /> Address ...... City ••-. WC- .... <br /> E Contractor's Name <br /> iap, *� License # <br /> a ._,_. Phone ��......... <br /> �,-------•---�---p•-•-- - - -•---- --- -•:-•- �-- ---- -- Via- , � <br /> Installation will serve: Residence Apartment Hous Commercial OTraller Court 0 <br /> Motel ❑Other ---------------------------------------------- \ <br /> kNumber of living units:___ Number of bedrooms Garba' a Grinde �, Lot Size .__.__. .�#c44-„r-_ _________ _ __ <br />' 9 - <br /> Water Supply: Public System and name --- • a-- -------,----..._..........................................Private r:10I <br /> Character of soil to a depth.of 3 feet: Sando. Silto, ,Clay ❑ Peat❑ Sandy Wall 0 Clay Loam:0 I <br /> f <br /> Hardpan 0 p Adobe a <br />� e *.Fill Mater#al ._..._...... 1f yes,type............... .... .... - � <br /> E'•s {Plot plan, showing size of lot,.!,location of system in relation',fo wells, buildings,.etc. must be placed on reverse side.).1'a <br />'r. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet;j . <br /> PACKAGE TREATMENT ( .SEPTIC TANK Size_+.lb�p? ------ •_4_Z.r---------------- Liquid Depth .......................... <br /> Capacity lss 1TYP® _ "` Material p <br /> P } 1 No. Com artments <br /> - G 1` .......•. <br /> Distanceto nearest: Well h- '�T ��..•----a._.....Foundation ______________________ Prop. Line --••--••__-_•-••-i�- <br /> LEACHING LINE [ } No. of Lines -•------ --------------- Length of each line., <br /> l � line..-._.. - ! • Total Length ..... <br /> 'D' Box ............ TYip Filter Material Depth Filter Material ---- ..........j........... ._ ....... <br /> t C 1 Depth • to nearest: Well :- .............. Foundation ......................:. Property Line ......................... <br /> .Distance <br /> SEEPAGE PIT '. ' ...:.. •Diameter 4 .lNuFnbe -.............. Rock Filled Yea: � "No <br /> �. : <br /> • <br /> Waterx Table Depth ----- ' S <br /> ............... <br /> oSize -------------..--------- ------- <br /> i <br /> Distancei'to nearest: Well ................... ..' .. T: -==Foundation ----- -•=_°--,..:... Prop. Line ....... :: - <br /> REPAIR ADDITION 1Prev. Sanitcl n Permit.'.-:::_.5. :,- Date <br /> Septic Tank (Specify Requirements(. --•-•......................................•••. •---- - .......... .- =U - ...:.•......... <br /> . 5.Disposal Field (Specify Requirsmentsl l j- -------------------------------------- ........................... <br /> --------------------------- <br /> S�._... <br /> ------ •- --�............... f <br /> ii (Draw existing and required addition on reverse side) = ;` <br /> 1 hereby certify that l have prepared this application and that the work will be donie�ins accordance with San Joaqule <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner or liceia �;w <br /> sed agents signature certifies the following: I <br /> "I certify that in the performance of the work for which this permit is lssued,.l-shall-not employ anyi person In-such rimanner <br /> as to become subject to Workman's Compensation laws of California." <br /> Sined <br /> 9 ............................................. Owner <br /> ' BY - i �I Title <br /> (If other than owned <br /> 11 <br /> I�. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY C= ---•0 ----- - --- ----------- --------- ------- ---- ....... ©A .........---- --- <br /> BUILDING PERMIT 18SUED ---•------'ll- - =.=='.� "= ':: _RATE ... <br /> ..--... .................... <br /> ADDITIONAL COMMENTS .:_...._. ---------------- = ---------------'---- ........ -'--•- ....................... .._... ... .........:_..._.. <br /> ------------------ ---------....._ ....----•------------------•---...... -----------...-------- --------- ----------- .............. ---••-•------ ....... ...... <br /> -------------- ---------------------------• --------- .................... .......... .--......---- -----......._....,._......... <br /> ii ........... <br /> Final Inspection by: ............. ..-_._ a .-_ <br /> --------------- Date . - .. <br /> EH 13 2h 1—bfi 1�sv. ��:; ------------ <br /> N JOAQUIN LOCAL WEALTH DISTRICT --8/7h 3M <br /> _ j p 14 <br />