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rVX UPTILZ Ubt: <br /> v--.. ....................... .............. <br /> APPLICATION FOR SANITATION PERMIT <br /> _ Permit No. 2.7:.Z� <br /> (Complete in Trlpllcatel <br /> ......................................................... <br /> This Permit Expires 1 Year From Date Issued Date Issued . ..:.:........ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constnicf and install the work herein <br /> described. This application is mode In compliance with County Ordinance No. 549 and exlsting Rules and Regulatlonst <br /> . -- �'. ...........CENSUS TRACT JOB ADDLESS/iOCATION ,- Z1 '...... <br /> Owner's Name ....✓............... .:::.. ............." y ...Phone .................................... <br /> Address ...........C7 ......- � '�r. ,�_r Z.. e t .. ._..City ..... ..............................................�..... <br /> Contractor's Nam® ..................................License#0_4_4 cp... Phone -•--------......_.. ........ <br /> Installation will serve: Residence[51 Apartment House 0 Commercial OTrgilei Court [3 <br /> Motel 0 Other----------------------------------- <br /> i t <br /> Number of.living units:...1 Number of bedrooms --�`�.....Garbage Grinder .......---- Lot Size .�1� ......... <br /> Water Supply: Pudic System and nam_a ....... .. ......» ... -.... ..:..................... ' .......Prhrate' <br /> Character of soil to a depth of 3 feet: Sand)] Silt`[] Clay 0 Peat 0Sar dy.'Loam 0 Clay Loam 0 <br /> . Hardpan Adobe fl Fill Motewai .... .. If yes.type............y ............ I <br /> !Plat pian, showing sire of lar, location of system in retationrto wells, uild�ngs; etc. must be placed an reverse- side.) <br /> _ NEW INSTALLATION: (No septic tank or seepage pit permitter# if-public i<ewer is available within 900 feet,l <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I,]: J Slie.'S K,g ..?�:�7J ....i......... Uquid Depth ...6-1v ....... <br /> f J <br /> Capacity .1 = TYPe-'. ei35 Materlal:............. ....... No. Compartments .. ......._---.. <br /> Distance to nearest: Well' ,. . <br /> I _:.�.....:::'.... Foundation .. ........... Prop. Line �.............J <br /> LEACHING LINE [ ) No. of Lines .�................. Lengtli,4 a`ch`ilne.... :��. .. : . � <br /> .... Total Length :Q.. .......... <br /> 'D' Box ...... Type Filter Material ,/, . -'Depth Filter. <br /> Materlal ,/:";F..................... ... ... .n <br /> t Distance to nearestt Well .1A0.-%:;... ....... FdUndation .. g.............. Property Line .............. <br /> EEPAGE PIT Q ), Depth .......... Diometer i;-53.`./. 'Number ........5................ Rock Filled Yes,V No 0- <br /> I Water Table Depth .............: :..:.`.:: f .... • . .Rock Size.....................wa... <br /> Distance to nearest: Well ........... .Foundation .:.......... ...:"`Prop. Line <br /> ' -. ...........REPAIR/ADDITION IPrev. Sanitation Permit# ............................. `..4 r Date .............. .. <br /> ' ... ........... .) <br /> Septic Tank (Speclfy Requirements) ..:............... ..,�.- . ,\i .#' ,- ............. ' .» .................................... <br /> ............. <br /> Disposol Field'(Specify Requirements) ........................................ :...p.............1... <br /> - <br /> ..........................................................................................................-................................................................................. <br /> ...,.............................................................................................t .................... .. .................................,....._.....,....... <br /> (Draw existing and required addition on reversa side) <br /> } I hereby certify that I have prepared this applicatlon-and that the work will be done In accordance with Son loaq% <br /> County Ordinances, State Laws. and Rules and Regutations of the San Joaquin Local Health District. Horne owner or licei <br /> 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£ernpioy any person In such manna <br /> as to become subject !_=77 <br /> Wrk n's Compensation taws of California." <br /> Sign V. ........... ... ............................` ' r <br /> $Y ..... . .. .........?.. ::�..................-....�.....�............... title ...............:.... <br /> r. �..2 -pf other thon-owner)----- r ._.�, �kx . - -„ <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..�_:.. ..... DATE .... � .. <br /> ............................................... <br /> BUILDING PERMIT ISSUED ........................................DATE-................. ... <br /> ADDITIONAL COMMENTS ...... . ..-- <br /> .. <br /> ! ..... .......................... <br /> - ---------------- ---- ..-- ........... ...... <br /> ------ ...............-............ ... <br /> -- .................--.............--.--......-----.......... . .....................................-----........ <br /> 2 ....................... .... ................ <br /> Fina! Ins ettion b .... .. .... ... ..... .. .. ...... . . .._....Date . <br /> IFF! l I n by ��- � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />