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FM OFFICE USE: ION ' <br /> SANITATION PERMIT <br /> . APPLICAT <br /> �-�........................ (ComFOR pleH M Trlpncotel Per"No. .: ....... <br />........................................... <br /> ............ This Penult Expires t Year From Dela issued Date issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSATION . ® .. .... .:....... .. ................................. .....CENSUS TRACT .......................... <br /> Owner's Name � :....... ............................. ... ............ ............Phone .................................... <br /> Address .. .Ch 'G'...ae�!�. �' .. ........................................City .."...-C .— .................. ......... <br /> Contractor's Name ... �� .r... ..............................................License# ? Phone .. .l�.t `: <br /> Installation will serve: Re donee g[.Apartment House i] Commercial❑Trailer Court 0 <br /> Motel Q Other---••--••................................... <br /> Number of living units:............ Number of bedrooms .9.....Garbage Grinder ............ Lot Size ...................................... .. <br /> Water Supply: Public System and name ................................................................_..........................................Privalle 19-'` <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fl day loam❑ <br /> Hardpan❑ Adobe❑ Fill Materkrl ............If yes,type. .....•...... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse ".)Ir <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) �. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size.. ......................................... liquid Depth .......................... <br /> Capacity j,�4P- �F90o . . Material...................... No. Compartments .`.f�..r.......... <br /> Distance to nearest: Well .... ...................Foundation ...................... Prop. Line..............._.... <br /> LEACHING LINE [ ) No. of Lines .-P,..�................... Length of each line.7 ................... Total Length -2j... ...... <br /> 'D' Box .,/....... Type Filter Materiallxor# - Depth Filter Material .r�..If............................. <br /> • , Distance to nearest: Well ........................ Foundation ........................ Property Line ................ <br /> SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No (] <br /> Water Table Depth ................................................Rock Size ................................ <br /> Distance to nearest:Well ........................................Foundation ........_........... Prop. Lila ........._........... <br /> REPAIR/ADDiTION(Prev. Sanitation Permit# ............................................ Date .................................1 <br /> SepticTank (Specify Requirements) ......................................... ._...................................._....---................, ..........-................ <br /> Disposal Field (Specify Requirements) ......................................•--............................................................................................ <br /> .......................................................................................................................................................................................................... <br /> .................................................................................................••...................................................................................................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance VA* Son Jeegtdrr <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Herne owner er Newt- <br /> sod <br /> eemsed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, 1 shatl not employ any person In such manner <br /> as to become subled to orkman's Compensation laws of California." <br /> Signed ...1 ..1!<;- _ ... ........................................... Owner <br /> 14k, <br /> B ............w .... ........................... .................... itle ............................................................ ........ <br /> Of other than owner) <br /> ARTME T USE ONLY <br /> APPLICATION ACCEPTED B.Y .. .................... <br /> ..... ................. DATE ... ....�.:.. ......._ <br /> BUILDING PERMIT ISSUED.......................................................... ....DATE <br /> ADDITIONAL COMMENTS ................................................................. <br /> ................................................................................................------....................................................:..................................... <br /> .......................................................... .................................................... <br /> .... .... . . . <br /> ....... ..... ............. .. ......: ....... <br /> .............. ........................................... <br /> Final lnspection by .......DnM <br /> Eli 13 2h 1-611 a• � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />