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FOR OFFICE USE. APFLICATION FOR SANITATION PERMIT <br /> ----- \�---------- s ''* Permit N6. <br /> (Complete in Triplicate) • <br /> �,. . ,�_..,. Date Issued <br /> ----" '"'"` '"This Permit Ex_pires^1'JYedr Froitm'Date Issued <br /> Application is hereby made to the San Joaquin Local Health Distric4fsor a Ier1.rr it to construct and install the work herein <br /> described. This application is made in compliance with County Ordind�ce No.`54 9..and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION __ - --- lt°r ,--...*--CENSUS TRACT --�:-��_-._--- <br /> Ndrrae -.0-446-If <br /> ' /'--��-��--Cry------------------------------------- <br /> 0 <br /> -------- ---------------------- --------------- -t-..--Ph ne ------------------------------------ <br /> Owner's <br /> Address ------lsl%?- - - - �------------------------------------------------------------------- City � � _�_-------------/----------.... <br /> Contractor's Name f�F r ` ZX <br /> r License #f �� Plione76 �, <br /> to <br /> Installation will se ve: ResidenceApartment House❑ Commercial:❑Trailer Court ;El' <br /> IV Motel ❑ Other -------------- ------------------------ <br /> Number of.�living units;ir' ,_ -_ Number of bedrooms �------Garbage Grinder -/ -4P Lot Size ------------ -_- --..----- <br /> Water Supply: Public Syffem nd-§name f3- '1-1�x ht_/_�y_ Q - =- --=-=-------- "---'----------- Private El <br /> Character of.1soil to a dept o 3 feet:" 'a '❑ Silt❑k Clay ❑ Peat❑ Sandy Loam .E] ClaLoam <br /> rHardpan EJ Adobe X Fill Material -_._--.---- 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 /> T <br /> t a <br /> NEW INSTALLATION:{ No septic tank or seepage pit permitted if public sewer is available within 200 feet,) =3 <br /> - `� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ]V �`, Size---------------------------;-------------------- Liquid Depth ---------------------.----- i <br /> � a I T' <br /> Ca acit + --_,J_'°T e -------------------- Material---------------------- No. Compartments _.-----"__------.--•-- <br /> � P Y -------- � � - YP � t V <br /> Distance to nearest:+well ------i-----------------------------Foundatio ----------------- --- Prop. Line ----------------------- <br /> LEACHING LINE No. of Lines ----- -.. .Y------- Length of each line--_447 --------- Total Length ,_,r �_ ___________ <br /> f �/ 4 .l / /YO <br /> Bax N-O_ Type;Filter Material $,e! Deptli_Filte;Material _ --------- ---------------- <br /> Distance to nearest: Well _-__' — Foundation -1.49---- Property'Line. ------------- <br /> �^ : t' �1 <br /> SEEPAGE PIT Depth _^.t/---�,-- Diameter ------ Number ..- t____--. -------------.-- Rock Filled YesX No 0 <br /> Z 4r- <br /> F Water Table Depth A--/----ujg�,O—------------------------Rock Sze -/-- --------------------- <br /> Distance <br /> ------j -----Distance to nearest: Well --_-.---'r------------------ ------Foundation -------AV Prop. Line -- _-_....__-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# A------------------------------------- --- Date --- -----------------------------) <br /> SepticTank (Specify Requirements) ---- ------------------------------------------------------------- ----------------------------------«-----------------------': <br /> Disposal Field (Specify <br />' Requirements) --------------------------------------------------------------- ------------------------- ------------------- ------------- <br /> -- <br /> ------------- <br /> -------------------------------------------- <br /> •--------------------- - <br /> - <br /> r� <br /> " <br /> - --- <br /> (Draw existing and required additibmon 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 /> k County Ordinances, State Laws, and Rules and Regulations of the. Son'Joaquin Local Health District. Home owner or licen- <br /> h sed agents signature iertifies-the followirib'`" ,.- i i <br /> i "I certify that in. his permit,is - <br /> the performance of the work for which,tssued, I shall not employ any person in such manner <br /> as to become subject to Workman's CompensaY n laws of°Ca'lifornia.:' <br /> Signed -- .t -- -------------------- <br /> --- - . --- <br /> -------------I----------- --- ----------------- ------- ----- ;-- -` Owner <br /> BY ------------------ .-A----------------------- Title ------......a� - -1°--------------------------- <br /> r (Ifothe an owner} _1 } <br /> 4FDRIDEPARTMENT USE ONLY .f. <br /> t - <br /> e -------------- DATE --------------- <br /> APPLICATION -ACCEPTED .B - <br /> BUILDINGPERMIT ISSUE ---------------------------------------------------------- ------------------------------ --------------DATE ------------------------------------------ <br /> ADDITIONAL COMMENTS ----- 1Z--- -----fe------------------- ------------------------- --------------------------- <br /> ------ �.. - ?- 7� r_���_,-_��S- ----------------------- <br /> _ -- -- -- - -- ------------- - -------------------------------------------------- ----- {rDat-- . ------ <br /> Final Inspection by: ---------------------------------------------- ----------------------------- - e <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1�)68'Reu:"5M - ' <br />