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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. . ................... <br /> . <br /> i This Permit Expires 1 Year From Dam Issued Date issued�d.:. / <br /> Application is hereby made to'!he San Joaquin Local Heaith District for a permit to construct and install the work herein <br /> described.This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION �~ _ <br /> ...!d_�.../ 7_.J..�...--..��. .. ...... ... ........ ...... . .. _-U4....CENSUS TRACT .....�......... <br /> .... <br /> Owner's Name ..................... !,.�.. Phone <br /> a... <br />. Addrbss Ciry, <br /> License ATrZ . . Phare . i <br /> . . ••... <br /> ¢-910 <br /> Contractor's Marne......... <br /> -.- .. , <br /> Installation will serve: , Residence Apartment House 0 Commercial❑Trailer Court 0 <br /> ! Motel 0 Other..---••--•---....__........................ <br /> Number of�living Units:...... ...,Number of bedrooms :....:...Garbage Grinder ............ Lot Size :��-�.x..- . .-.. <br /> s <br /> x <br /> Water Supply: Public System 'and name .:................:.....................................�.....:.............................................Private❑ : <br /> Character of soil to a depth of 3 feet, Sand"❑ Silt© Clay ❑ Peat[] Sandy Loam ❑ Clay Loam ❑ • <br /> �! Hardpan 0 Adobe Fill Material ............if yes.type............................ <br /> {Plot plan, showing size of loth location of system in relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: {No s jItic tank or see ` <br /> page pit permitted if public sewer is available within 2{)0 feet,j <br /> m; <br /> dh <br /> PACKAGE.TREATMENT { ] . SEPTIC TANK( j Size...........................I..................... Liquid Depth ................... <br /> _ Capacity ..................... Type .................... Material....................... No. Compartments ...................... <br /> Distance` to nearest: Well Foundation Prop:tLlne <br /> LEACHING LINE [ j . No. of�Lines Length of each line....... ...........:-°'Total Length ..........._............._. h <br /> d <br /> D' Box .......1x.,' 1l."111tee Material .. ''...Depth Filter Material ............. ............................. �* <br /> Distance to nearest V°a' $...::........._.:._... Foundation .......:. ..................... <br /> SEEPAGE PIT [ j Depth'III:.................. DiampUr .:.7,. . ... Number .....-..........-(.......... Rock Filled Yes ❑ No 0- <br /> 0 - <br /> � Water 0 6-1 l7epth. ..r •* * # .............Rock Site .. S <br /> .{}isfancel to nearest: Well ............. ........`?..`iZ,,'Orap. Line <br /> T .a NR/JIDDi*lON(Prev. 5anl�p Permit° �:.=.u.. ..........�,... Date................................... <br /> i u <br /> r.^ _ Septic Tank (Specify`i ulrerill <br /> ents) l ..................... <br /> ?:�............... <br /> II .... .... ... ............................ "ti.. <br /> Disposal Fielcf,1�pecify Requirements) ..... r ...... ..................... <br /> .--..-... • L....... ..... .. "�•� -----------•-----•---_......- <br /> "^� .. .... ........._...............:.......I........._......:} I,'?.......r........... .- # y <br /> III; (Draw existing and required addition oh reverse sl 1'j", `; I <br /> i� I hereby certify that I have prapared this application.and that the werll will be dune in ecce frdbnce with San Joaquin <br /> County Ordinances, State Lawo l and Rules and Repulla ans_of.,thr..Sae..Jeaquln Local!Health District.H a owner or Ifaf►. <br /> " is signature certifier tha'IifoflowlnOr <br /> "I certify that In tho peiformamc of the work for which this permit Is Issued, I shall not empiey any par�en In such manner <br /> f� .as.to become subjectto.Warkmnn's.Componsation laws of California." <br /> Signed ........ .......... <br /> .. .. ............... <br /> 'N <br /> By.:............. ..... �.....-.-.--. -� ..-.......:f. 4 Title -.-,........-.. ... - <br /> .. . <br /> ­ <br /> (If other tho nor) <br /> AftyDEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED Y .,.'ii'P.- <br /> /!/� ..... ..............................................................DATE ............................................rbr��T ,. <br /> I� ^� <br /> . -..- x <br /> BUILDING PERMIT ISSUED ........ <br /> ADDITIONALCOMMENTS........ ........ .............. .....................................-....-.....,:- ..........-.-..................,....................-........... <br /> .. <br /> ............................. ........... .iE ............,..... ..,........... ............................-........... .......... ............................... <br /> Final Inspection bye <br /> . ..........................•.........................--....................... ........ ... .... .... .... <br /> ...-..... ... ....Date :.�/...:��.- . <br />