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FORDO" USE t <br /> APPLICATION FOR SANITATION IBM <br />.................................... ................... Permit No. ...................... <br /> ............... ....... 94,1 lComploto In TrIplicate1l <br /> Date Issued!.............I... <br />.... .... . .......... ...................... This Permit Expires I Year From Date 1999W <br /> Application Is hereby to the San Joaquin Local Health District for a permit to consvdct and Install the work herein <br /> descr <br /> jiW_Thls a tion Is made In compliance with County Ordinanc No. 549 and existing Rules and Regulotlonst <br /> A �%t <br /> ........................ <br /> OB ADDR TI . . . ... .......... ... ... ...........7..........CENSUS TRACT <br /> nor's ���. .. . <br /> ........ .. .. .. ...... . ...... ........ ..... ........ Phone <br /> gt .. ............... <br /> 4 ............................................ <br /> Address 001. . ..7��.4 ....... City <br /> Contractor's Name ...........4,7 ... Phone <br /> . .. ....... ..............................License# aM,&& ..S__ <br /> ...................... <br /> Installation will serves Residence 0 Apartment House(] Commercial l )TrWlw Court 0 <br /> Motel 0 Other....................................... <br /> Number of living units,...../.. Number of bedrooms � Garbage Grinder ............ Lot Mn ............. <br /> Water Supply: Public System and name .......................................................................................................privatoo <br /> Character of soil to a depth of 3 feet: Sand E3 Silt 0 Clay 0 Pow(3 Sandy Lown 0 Clay Logen 0 <br /> Hardpan[3 Adobe[ Fill Waterial ............If V*16 type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, oft must be placed on reverse sId!:1U) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 fest,) <br /> PACKAGE TREATMENT SEPTIC TANK Sh* ....... Liquid Depth ... .......... <br /> , P'toe%a.—... .. ...—***'*' *-- . .. . <br /> ..... ..Q <br /> Capacity 4P4�..... Ty ..t............. Material-SMIC ...... No. Compartments <br /> Distance to nearest: Well ......6_..?. .............---.......Foundation. .......... Prop. Line <br /> TEACHING LINE No. of Line <br /> si��............. Length ofeach line.1 ....4F ....... Total Longth .12.!g..............:r_1 <br /> W­- CV. /0 <br /> V Box ............ Type Filter Motorlal '�?P ..Depth Mar Malarial -.1-49............................... <br /> -9- .. <br /> Distance to nearest, Well .-45_z�....... Foundation ...le.............. Property Line ............. .. <br /> F <br /> of <br /> SEEPAGE PIT Depth .--.-;Z�f....... Diameter .;N;!........ Number ........ .............. Rack Filled Yes No O� <br /> Water Table Depth ........... .. ...................Rack Sin ............. <br /> 40 r Y <br /> Distance to nearest, Well .../00..........................Foundation . .......... Prop. Line .;E............... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ................................ <br /> SepticTank (Specify Requirements) ...................................................... . ........................««.....:...................»........................... <br /> DisposalField (Specify Requirements) .................................................................................................................................... <br /> .............................................................................................................................................................................................. <br /> .......................................................................................................................................................................................... <br /> (Draw existing and required addition on reverse sW <br /> I hereby codify that I have prepared this application and that the work will be done In acewdence with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son JmMuln Low Me" District. Home evoor or Ilcon- <br /> sod agents signature codifies the following: <br /> "I certify that In the performance of the work for which this permit Is Issued, I shall no employ any person In such manner <br /> as to becom ub ect to Workman's Compensation laws of California." <br /> - I — Owner <br /> 5;gned ....... ....Z0.0..�.. ............................. <br /> -en <br /> By ..... ............. ........V,4 ................................................. <br /> ........... . ............................. <br /> (if other than owned _t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYaA. e <br /> ..................... <br /> ... ........ ...... DATE <br /> BUILDINGPERMIT ISSUED .......................... ........................................... ..................................DATE-.:........................................ <br /> ADDITIONALCOMMENTS . .......................................................................................... ...... .................................................. <br /> ................ ............................................................................................... .................................................. <br /> .. .............. <br /> ..............I.......................... ..........................................I.... ........... ...................... <br /> ................. ............... .......**'*'**......**......... <br /> )GI Inspection by.. ... ........................................................ ................ ..............Date ... ................ <br /> 13 2h 1-60 94 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br />