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. FOR OFFICE USE: <br /> SPI APPLICAI'i®N. FOR SANITATION PERMIT <br /> y (Complete in Triplicate) Permit No. ..................... <br /> ............ . .. ..............._ This Permit Expires I Year from Date issued <br /> Dote-Issu@d .lY" � � <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 County Ordi No. 549 and existing Rules and Regulations: <br /> a _ <br /> 108 ADDRESS/LOCAT ... .. ..... - �_G AY_.... .. ....................CENS6S TRACT i <br /> Owner's Name .. .. ......0. ............ . � ... <br /> Address ........... ............ <br /> f <br /> - _ ..., F.1 fir.. pity .. ......__._...... <br /> "// ` <br /> Contractor's Nam .i_ .&._..._-- --- ...... one Sa <br /> r1 .. :..License ...... /_.�., Ph .. �.I ... f <br /> Installation will serve: Residence artment:Housefl Commercial QTraller Court 0 <br /> Motel Q Other............ <br /> Number of living units_____________ Number of bedrooms: arbage Gr€nder s?. Lot Slza <br /> t Water Supply: Public System and namePrivate <br /> .....0la 0Peat----•--•-------- ........._. ......... . .. <br /> Character of soli to a depth of 3 feet: Sand El Silt❑ y [:1 Sandyfl. <br /> Loam Cla.. _Loam <br /> Hardpan Q <br /> Adobe Fill Materia -•--P----- If yes,type ............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION:.., (No septic tank or seepage pit .permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size................................................ Liquid Depth <br /> Capacity Type Material-------------- --- No. Compartments <br /> Distance to nearest: Well .....:......... .......•.........Foundation . <br /> ! <br /> NG <br /> • ---- ..................... Prop. Line ---------............. <br /> LEACHING LINE [ ] No. of lines ; ..:.--:_-- Length of each line..................... <br /> ------------• ._..... Total Length <br /> 'D' Sox Type Filter Material ------.Depth Filter Material <br /> Distance. to-neorest:=We#i ___.--_ Foundation~ <br /> ---•_...-----� ..------- <br /> ..............: Property Line ............. � <br /> SEEPAGE PIT [ j rDepth . __..-- Diameter ---------------- Number ............................ Rock Filled Yes ❑ No ❑ <br /> Water Table Depth -----------.Rock Size ._........------..._. <br /> .......•-- <br /> Distance to nearest: Well ---------------- ------- -- ------Foundation . Prop. Line ....................... <br /> REPAIR/ADDITION{Prev. Sanitation Permit# ............_................ .. .___._....Date ........................... <br /> Septic Tank (Specify Requirements) ------------------------------------ <br /> ----------------- <br /> Disposal <br /> __:...._ ------... ..Disposal Field (Specify Requirements) ---- _-...-- -•--•_........... <br /> --- <br /> ----- <br /> 7---------•-- . ---- <br /> ­/-------------- ................ ................ <br /> •-- ........ .........----------------------------- ----------- .......................... <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 Laws, and Rules and Regulations of the Son Joaquin Local Health;Dlstdcf. Home owner or licen-._ � <br /> sed agents signature certifies the following: 1. �- . - , <br /> "I 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 become subject to Workman's Compensation laws of California." <br /> Signed ----- ------•--•-- Owner <br /> J.... <br /> • <br /> SY ...... . < --- - - ------ -- •--------- -------------• ----------• Title :...._- ' l � <br /> (If th than owner) <br /> ...... ... <br /> FOR DEPARTMENT USE ONLY <br /> PLICATION ACCEPTED BY /__ <br /> - <br /> BUILDING PERMIT ISSUED -- •- - . -- __.. DATE <br /> _.. • ---•-••----------------- <br /> ADDITIONAL COMMENTS --- ----- - - --------- DATE <br /> --------------- -•----....,..-------•-----...---- -•.._...---•------- ----....---.....__....--------•-•....-----.._.._.. <br /> -••_____.........._--------------------_------------___ ________ ..___.-_.._._-__._.._-..._._.._.____.._._.._. ....__...._-.__-_.._ <br /> Final Inspection by- --------------- <br /> ._Date .... ._:. y-- <br /> El-i 13 2h1-6t1 Rev. •-•----- ---- -----• -•--- - •-- - ---- -... --.------ .............. <br /> SAN JOAQUIN LO AL HEALTH DISTRICT 874 3M <br />