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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) I <br /> - -- ---- ------------------------ Dot; Issued <br /> I This 4ires I Year From Date Issued <br /> Permit <br /> -onstruct and install the work herein <br /> Appl icat',6rVheretby'm-ode Ctf' t"e /n Joaquin Local Health District-for-a-per'mit to <br /> rd once. No 549 and Rxisting Rulesland Regulations: <br /> p ica ion i rTjode qn Fo <br /> described. This cip Ii d mpli ce ith Cou <br /> SUS TRA' CT -------------------------- <br /> --------------------- - ------- <br /> JOB ADDRESS/LOC - --------- t --- <br /> I `�:-------- --I-Phone <br /> Owner's Nam --- ------ --------------------------- <br /> c7r) - ------------------- City -- ------- --------------------------------- <br /> Address ZZA ...... V4�� <br /> ....jC ----------License <br /> Contractor's Name <br /> flation will serve. ommercial*ra-ileir Court 0 <br /> Insta Residence [3 Apartment House�E]IC <br /> Motel []Other -------------------------------------------- <br /> Number of livin6 units----- -------- Number of bedroom' s ------------Garbage Grinder ------------ Lot Size --------- <br /> 4 4 1 - -------- ----------Private>( <br /> Water Supply. L!blic System and name -------------------------------- ----------------------- -------------- <br /> S ndy Loom Ej Cl�y Lo <br /> Character of soil to a depth of 3 feet.. ' Sand' Silt 0 Cl a y El Peat El' <br /> Hardpan E] Xdobe�E] Fill Mra�tericij Iflyes, typo.A.,,�- <br /> rse side.) <br /> (Pl'ot plan, showing size of lot, location of system' in relation to �yells,lbuildings, etc. must be placed on reve <br /> pit permitted if public sewer is available within 200 feet�) W <br /> NEW INSTALCATION: (No septic tanror seepage <br /> PACKAGE TREATMENT I I SEPTIC TANK --- ---------- Liquid Pepth ---- ------------ <br /> y1i, Ty ments ------ <br /> Capacity pe 64t Materici'l ------ No. Comport . .. ... <br /> Distance to i7earest: Veil ------------ ------I-Founclation - ------- P <br /> rop. Line <br /> 1,in e 070 Total Length <br /> No. of Lines,------------------ ----- Length o <br /> LEACHING LINEr 7 <br /> 'D' Box DepthOFilter Material --------- .......... <br /> ----/---- Type Filter Materia -.'I - , I <br /> Distance to nearest: Wel 0 1 ------------------------ Foundation -------------------------%rope" Line- ------- ----------- <br /> 41 W L-.IL- I No 0 <br /> SEEPAGE PIT Depth ------------------- Diameter ---------------- Number --------1--�------------------ Rock Filled Yes <br /> Water Table Depth ----- ----------------------I----------i------tRack-Size --------------------------- <br /> 7 E I ') , - <br /> Foundation ---- ---------- Prop. Line ... ------ ....... <br /> Distance to nearest: Well -------------------------------- ------ -4 <br /> REPAIR/ADDITION(Prev, Sonifation Permit# ----j--------------------------------------- Date ----------------------- <br /> Septic Tank (Specify Requirements) -------- ------- ------------ ---------------------------------------------------------------------------------------------------------------- <br /> Disposal Field (Specify Requirements) ---------i--------------------------------------------------------------------------- -------I--------------------------------------- <br /> A-------------- ---------- — ----------- <br /> ---------- ---------------------------------------------------------------------- -------------------------------------------------------------------------------- <br /> -------------------------------------------------- -------------------------------------------------------------------- --------------------------------------------i-------------- ------------------- <br /> (Draw existing brid required addition on reverse side) <br /> X' I Joaquin <br /> I hereby certify that I have prepared this application and that the work will be done iri accordance with Sat <br /> County Ordinances, State Laws, iind Rules and Regulations of the San Joaquin Local Health Distriit. Home owner or licen- <br /> sed agents signature certifies the following; <br /> N anner <br /> "I certify that in the performance of the work for which this <br /> _permit is issued, I shall not employ any person in such m <br /> as to be!�"3e s biqct to or n's Co ion laws of California." <br /> _12b .. ------------- ---- Owner <br /> Signed - -- ----------- <br /> By ----------------------- -------- \Title ----------------- <br /> (if other than <br /> \YPR DEPARTMENT USE ONLY <br /> K r <br /> _4-- ------ -- <br /> APPLICATIONACCEPTED BY ----- -------------- - --- ----------- -------------------------- --------------------------------- DATE .-'--- -------- --- <br /> ----------DATE ------------------------------------ <br /> BUILDING PERMIT ISSUED ------ --------------------------------------- ------------------------ <br /> --------------------- <br /> ADDITIONALCOMMENTS ----------------- ------------------------------------------- --------- --------------------------------- ----- -------------- <br /> ---------------------------------- ---------I----------------------------------------------------------------------- ---- <br /> ---------------------------------------------------------- ------------ ----- ----- <br /> ---------------------------------------- ---------------------------------------------- <br /> ------------------------------------------ ------------ -------------------------------------------- <br /> .I - -------------\--------------------------------- -------------------------- -------------- ------ <br /> ----------------------------------- k Date f--------- --------------- ------ ------- <br /> Final Inspection by ---- - ------- ----- ---------------------------- -------------- <br /> SAN JOAQUIN LOCAL HEALTH, DISTRICT <br /> E, H. 9 1-'68 Rev. 5M <br />