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FOR OFFICE USE <br /> APPLICATION FOR SANITATION PHtM . <br />................................................................................................... �\ IComplete In Triplicate! Permit No. . ...� <br /> .......... ............................................ This Permit Expires 1 Yew From Date Messed <br /> Date Issued <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to conw%;d and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 ani Misting Rules and Regulations, <br /> JOB ADDRESS/IOCAT ...J�. S -11 �cJ �##!�?. ..CHVS!!S TRACT .......................... <br /> Owner's Name .. .. .... . ... .. ........ . ......... ....................... .......... ..Phone .................................... <br /> Address . ._.--•--.�l1. `�.V. .. .................................... .. .. ... . .. .............................................. <br /> Contractor's Name ....... .. .............................Lkasnso# ss ..3.?��..... Phone .-.7. - . 1.��...... <br /> Installation will serves Residence MrAportment House Commercial Urai w Cotxt C3 <br /> Motel❑Other_ • - 4/7 <br /> Number of living unites../.... Number of bedrooms ....�...--Garbage Grinder • <br /> ........ . Lot On .�..................................... <br /> Water Supply, Public System and name .... <br /> ........................... _...................._..............»................................... <br /> prhrotte .. <br /> Character of soil to a depth of 3 foots Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom Q day Loam ❑ <br /> Hardpan Q Adobe Fill Motorial ............If yes,type........................... <br /> !Plot plan, showing size of lot, location of system M relation to wells, buildings, ete. must be placed on revers• side.) U <br /> NEW INSTALLATION: iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{1r— ..�........... Liquid Depth . ..C.t .�a:.......... Ll <br /> Capacity/.-P!- ....... Typer1fe&-iMaterlaIC49<z ...... No. Compartments ......... <br /> Distance to nearest: Well .....��.... . ................Foundation../10........... Prop. Line..r�...�`r.. ..... <br /> LEACHING LINE No. of line: .....- ...... Length of each lineee...c.94 .. . .... Total Length ..p........ <br /> 'D' Box ..I....... Type Filter Material Filter Material ...,�.t�............. .. ........ <br /> If <br /> Distance to nearest, Well .. lQ. Foundation ..0 Property Line <br /> SEEPAGE r '7r' _ .5- <br /> ........................ <br /> S GE PIT (yam Depth ..ate ......... Diameter .. lP........ Number ...... ........s....... Ra�k Filled Yes!" ' Or <br /> -- Water Table Depth .......AV....I... ...................Roa Ste!.G ..r .............. <br /> Distance to nearest: Well . .1.52).......................... Foundation .....1. ...... Prop. Line ......... ...........t <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ...............................11 <br /> SepticTank (Specify Requirements) ......................................... ....... ...........................»..»............................................... <br /> DisposalField (Specify Requirements) .................................................................................................................................... <br /> . ..................................................................................................................................»............................................................ <br /> . . ........................................................................................................ ..................... ...................___...................................\ <br /> (Draw existing and required addition on reverse*W ON <br /> I hereby certify that 1 have prepared this applicoten and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Leal Haft DiskIct.Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, i *hap net employ any person In such manner <br /> as to beco ble to Wo an• mpensatlon laws of Callfornla." <br /> Signed At <br /> — ..... ....................... Owner <br /> By ..... .......... . .... *. ....................... title ........ ................................................ <br /> (If othn owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... � .. ...:� ........... DATE ...... .� 3 ........... <br /> . . <br /> BUILDING PERMIT ISSUED ........................ ................... .......... DATE.:.................................. <br /> ...... <br /> ....... . ............................ <br /> ADDITIONAL COMMENTS .. .................................................. <br /> ..... ... ..... ................... ............................................................................................... .................................................. <br /> ............. ...................................---...-........................................................................... ....... ........................................... <br /> ....................... ..................................................................... ... ................. ............... .... ............. ......... .................. <br /> -. - ........ <br /> Final Inspection by: Q. ........................Date ... .�j�. <br /> EN 13 2h 1-60 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3H <br />