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Jr. Vil <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> � <br /> (Complete in Triplicate) Permit No. ..................... <br /> This Permit Expires I Year From Date Issued <br /> Date Issued .7. �'�?y <br /> Application is hereby made to the Son Joaquin Local Health District for a per 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 ADDRESS/LOCATION ,........ .. .,., j /e.N............................................................CENSUS TRACT .........Owner's Name _ I.. ..... . .t?. �.Q. ••-•--T..f...... .......... .... .Phone_?X.;7'26 ` 47_ <br /> _ <br /> k Address ._._. S'a_.�.__ r '. !!2k�Rl9' ------=-------------- ---- ........ City -------S.-71p.G gel ........................ ........ <br /> Contractor's Name .... WK-e�— ...License # Phone <br /> } installation will serve: ResidenceX Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other .............................................. <br /> Number of living units:............ Number of b drooms. •- .-_...Garrba'ge Grinder ...�__. Lot Size ...3_ � . " " .......... <br /> Water Supply: Publics stem and name ..... ...�1.(��P�...Ae e— rL-_:..._.. .Private ❑ <br /> M Character of soil to a depth of 3 feet; Sand'❑ ..Silt[]. Clay Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> Hardpan ❑ Adobe 'Q 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 /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) { y <br /> PACKAGE TREATMENT [ } SEPTIC TANK t } Size---------------------------------.................. Liquid Depth _..._ y.�_..__-- <br /> Capacity 1212Q.._.._. Type �G2t GJ�,., Material e,_4j1w1e.16rNo. Compartments <br /> Distance to nearest: Well ...... ..............Foundation I_Q� ... Prop. Line ._.,� .......... <br /> LEACHING LINE No. of Lines ___ Length of each line._____ ?10..,} . Total Length _ ............... <br /> 'D' Box y , .-Type Filter Material (r�.tt��:::.Depth Filter Material .......................................... 'J <br /> t �► <br /> Distance to nearest: Well -__ ....... Foundation .. ...:........... Property Line ... ".__'?! ._..... <br /> Depth ..__-... Diamefer ._._......• .... Number ............................ Rock Filled Yes ❑ No Q <br /> W� �p �_ �. Rock Size <br /> Iter Table be # .................... 1J' <br /> Distan to nearest: elite.................... --......---F3c�►dation ---- --- Prop. Line .................... <br /> REPAIR/ADDITION(Prev. Sanitation;Permit 5`- ...................... ............... Date .................................... <br /> Septic Tank (Specify Requirements) _.!--------------------------- -•--..._..__ ....... ............... ------........ .............................._.. ............. <br /> 4 <br /> iDisposal Field (Specify'RegUirements) .----------------------•------....._..-•----•--•-•------..._......_....----............_.......--•-------............................. <br /> s -------------------...............-......... . _..---•-.....f--•-_-----------------__--.---•--•-----......---•---•--•------...-•-•----.._....._...-•------...--•--.._._._.........................._ <br /> ....................... <br /> ....------------------ ----------------------------------- <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 sand Regulations of the Son Joaquin Local health District. dome owner or )icon- <br /> sed agents signature certifies the following.- <br /> "I <br /> ollowing://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 Califarnla." <br /> Signed . .......... c;b .. .. .................. ................ Owner <br /> BY .................................. <br /> Y -....--�--- <br /> --•-...---•----•--• -------..------:: Title <br /> ' ........................................................................ <br /> Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY :. ,G _ ..................................•------•---..... DATE .7t�_1'�.._..�. ................. <br /> �. BUILDING PERMIT ISSUED .... ........ ...................... DATE <br /> ........................................... <br /> ADDITIONAL. COMMENTS ................•---.................. .....----..............................-- :............ ........... <br /> ( ........... •..-----.. ......:................................................................•••.......... <br /> ----- ..............--------------------------------------------------- : --- ----------------•------•----------_----•--•- ---.-•_I.._._.._.._..-•------ ........ <br /> I <br /> Final Inspection by: '. •----•....... ................: Date _: ._.a =.. _............... <br /> SAN JOAQUIN -LOCAL' HEALTH DISTRICT <br /> r.- H-1.3 24 3.'6R Rate. 5M 772 3 M <br />