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pR <br /> OFFICE USE: APPl1CATION FOR SANITA��ON PERMIT <br /> Permit No. <br /> fete in Triplicate) /y <br /> I <br /> � [Comp <br /> - - ---------- --- ------------------- <br /> . . _ Date Issued ---------------- <br /> ires 1 Year From Date issued <br /> -------- ------ c This Permit Exp. <br /> ermit to construe# and install the workherein <br /> r Rules and Regulations: <br /> Application is hereby compliance ;th County Ord;nanc No. 549 and existing <br /> ppmade made in co q in Local Healfih District for a p <br /> _---CENSUS TRACT ---- <br /> desuibed. This application �- -- I <br /> JOB ADDRESS/LOCAT N ----------- <br /> -------------------Phone ------------------------ <br /> ---•--- <br /> ------------- <br /> Owner <br /> r <br /> - -- --- --- ------ -- ------- - . city --� - - <br /> Owner's Name --.- -----.----- <br /> �� 1 - Phone <br /> Address ..-�0"3'�- - -= ------ ;----- --------------- - -------- <br /> Contractor's <br /> -- - - - - -- -- -- - - - -------License # ----------------- -- - <br /> - <br /> _ �-`�_`- Trailer Court <br /> Contractor's Name _. - Commercial <br /> Residence Apartment House❑ <br /> Installation wiVV serve: , <br /> Other ----------- �3 --------- <br /> Motel ❑ - -- - - <br /> Lot Size-f`�---- ------- -- <br /> Garbdge Grinder - -- -- �-- private <br /> I units: 1.--- Number of bedrooms -.)� --------------------------------- <br /> -------------------- ------- <br /> Number of living <br /> _ <br /> i -------------------------------------------- <br /> -----•----- - Clay Loam . <br /> Water Supply: Public System and name ----------------------- Clay ❑ Peat❑ Sandy Loam �❑ <br /> 1 depth of 3 feet: Sand'❑ Silt❑ if yes,type <br /> Character of soil to a dap Fill Material ------- --- ��� <br /> Hardpan ❑ Adobe ❑ <br /> buildings, <br /> etc. must be placed on reverse side.l <br /> (Plot plan, showing size of lot, location of system ;n relation to '^1eublic sewer is available within 200 feet,l <br /> e it ermined if public <br /> � ' <br /> l NEW INSTALLATION- (No septic tank or seepage P p 4-- ------------ Liquid Depth `5� \ <br /> Size_ �---�---/-- -- - <br /> I No. Compartments ---- ------=---•--•--- G <br /> I PACKAGE TREATMEN [ ] SEPTIC TANK[ 1 <br /> /600�'�Type �` -r Material <br /> - o--rA-��------- Prop. Line --•---,�------ <br /> T Capacity ---------- e <br /> G---t--------- ----------Foundation - -�- IS`�.--------- 0 <br /> Distance to nearest: Well - : <br /> � _-- a Total Length ---- � <br /> No. of Lines --- <br /> Length of each line- _7t5 . .... -------- <br /> LEACHING LINE [ ]' _Depth Filter Material �5-------- ---�------� f <br /> -- Type Filter Material .� ` S4 -- --T�----•:_-•- <br /> 'D' Box � - Y � /p ��..--- -.-- Property Line. - --- r <br /> (` Distance to nearest: Well --bpd------------ Foundation � — a <br /> Depth _11- -------- -- Diameter �Xx J_ - - Number ---------- <br /> -____- Rock Filled Yes <br /> SEEPAGE PIT [ ] ----Rock Size ---------------------------- <br /> ------- d <br /> Water Table Dept ----------- Prop. Line ------------- -------- <br /> Distance ------Founda#ion °-- ----�--- ----- - <br /> Distance to nearest: Wel --------- <br /> • -------------------------------------------- Date ----- ----•-----------------------1 <br /> REPAIR/ADDITION(Prev. Sanitation Perm# <br /> i <br /> F Septic Tank (Specify Requirements)uirements) ----------------- <br /> --------"-----"------- <br /> ---------------------------------------- <br /> DisposalvField (Specify Requirements ----------- --------- ------------------------ <br /> ----------------------------------- <br /> ' --------------------------------------------------------- <br /> -------- ----- <br /> Son <br /> I <br /> (prow existing and required addition on reverse side) in <br /> e,in ac <br /> I hereby certify that I have prepared this application and <br /> that <br /> the San Joaquin the work will be <br /> donealth D ordance w towner or leen-- <br /> ict. Home <br /> County Ordinances, State Laws, and Rules and Regulate <br /> sed agents signature certifies the following:" person in such manner <br /> ! "I certify that in the performance of the work for which this permit is issued, I shall not employ any <br /> as to become subject to rkian's C <br /> nsatwn aws of California." <br /> Signed -- -- ----- ------ --- <br /> - Owner <br /> iBy 1. ------------------------- Title ------ ------- <br /> '' <br /> (1f other than owner)' <br /> FOR DEPART @N7 LI5E ONLY <br /> DATE -- ------�1 <br /> APPLICATION ACCEPTED BY <br /> --- - ----------------------------- ------------- DATE .-..-----------------------------------.--- <br /> - ----------------------- --------------------------------------=--------- -- - <br /> BUILDING PERMIT ISSUED --------------------------------------------------- <br /> ---------------- - -- - <br /> -- ----- <br /> ------------------------------------------------------------------ ---------------------------------------- <br /> ADDITIONAL COMMENTS --------------- __ ----- <br /> ` ---------------- ---------------------------------------- =----------------------------------------------------------- <br /> i ------- <br /> -------------- ------------------------ ------------------- <br /> - --- ------ - -- ------------ <br /> Date - . <br /> I Final Inspection b <br /> p ctiY r �"a <br /> SAN 10AO IN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6B Rev. 5M <br />