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I:OR OFFICE USE: APKICATION FOR SANITATION PERMIT <br /> (Complete In Tdplleatei Permit No. 2�,,--116.,7.. <br /> ..........I..................................... q2-11 Date Issued .3-:�t.`�.5� <br /> ......................................................... This Permit Expires I Year From Daft Issued . <br /> s <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 CountX Ordinance No. 549 and existing Rules and Regulations <br /> n <br /> JOB ADDRESS/LOCATi .. ...,/. --...... .... .... .t.�'- tn...!`�I:.CENSUS TRACT ................. <br /> Owner's Name .. 0?? c" w ....... ......... ......... Phone ...7.......................... <br /> Address ..._..Z .. c Q.X._....��.�...9..........................................................City ...!.VC.. tl3.G ............I.............................. <br /> Contractor's Name ......... .:.-•-------------------••- ........Licence# ......... Phone <br /> Installation will serve: ResidenceVApartment House 0 Commercial[3Trailor Court <br /> Motel ❑Other ........................ <br /> Number of living units:-.I...... Number of bedroom$ ......Garbago Grinder I........ Lot Size <br /> Water Supply: Public System and name ................................ ........._...._...................................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt[] Clay'❑ Peat Q Sandy Loam ❑ Clay Loam <br /> ---- Hardpan❑ Adobe O}-fill typo <br /> Material ............#yes, ............. ............ <br /> (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted If pukilc wwor is avaflable within 200 feet,) <br /> PACKAGE TREATMENT .V SE Liquid Dep : �1A <br /> CapadtV . Typ .� .- $tori$ No. Compartments ....... . .. �' <br /> Distance to nearest: Well ... . .(�... _.........Foundati ......... Prop. Line .2 ....... <br /> LEACHING LINE No. of Lines Length f each Ilne.. �... . <br /> . ... Total Length ..��.�� ....... <br /> 'D' Box �....... pe Filter Materiae. p Iltor Material .. .�. ............................ <br /> Distance to nearest: Well 140.4!... 1... Foundation ...... ,{..f...... Property Line ... U.........0 <br /> SEEPAGE IT ' Depth ..25........ Diameter -;. ...... Number ......... .. Rock Filled Yes No C <br /> Water Table Depth ........................... ..................Rack Sita ....... <br /> .....2-`.-`.'�/%.... <br /> Distance to nearest: Well ....1�0!..................Foundation -7.S ...... Prop. Line . ! ............ <br /> REPANVAUDITION JPrev. Sanitation Permit* .............:.............................. Date ..................................) <br /> Septic Tank (Specify Requirements) ....................................... ................................................................ ........................... <br /> r� <br /> Disposal Field (Specify Requirements) ..................................................................................................................................... <br /> .....................................................I.......................... ..........................._.............................................................................I.............. <br /> (Draw existing and required addition on reverse side) <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 Lows, and Rules and It"viations of the Son Joaquin Level No" District. Horse owner or Neew <br /> sed agents signature certifies the followMgs <br /> "1 certify that In the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to bocomo b)ect to W 's Compensation laws of California.,, <br /> Signed •--- <br /> .. .............. ................Owner <br /> By ................ ..................................................................................... litle .............._........._.................. ............................ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY... .. _..... ... ._............................ . DATE .�' ,�.. f?ti.. .......... <br /> BUILDING PERMIT ISSU D . :........... ........ ......./. . .. <br /> ` TE _.. . ........................ <br /> ADDITIONAL COMMS S ..s -2.7s �' u` ' ............. <br /> ._.. <br /> :.................. F. ..................... f ' <br /> Final Inspection... . ! ;�'l�ti t L _..... - <br /> b -...._. ......... - -----..._.Dat ............... .. <br /> EIN 13 2!t 1-68 Rev. � SAN JOAQUIN LOCAL HEALTH DISTRICT $-'7h <br /> 3M <br />