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OFFICE USE: <br /> . . l .?L f 1. APPLICATION FOR SANITATION PERMIT <br /> (7 lCerMptete to Trip"caw Permit No. <br /> .. ................................................... This Permit Expires 1 Year from Date issued Dass Issued .................... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> desuibed. This application is made in compliance with County Wdinance No. 509 and existing Rubs and Regulotionst <br /> JOB ADDRESS/LOCATI . ` <br /> -���fr�-� -.�....................J.A..7.1 ...... <br /> ....._.cam TRACT.-__..........._._....___. <br /> Owner's Name ..._ / .Phone <br /> 7 <br /> Address m. <br /> .--.-- ----•-• ...fid...... ��..f., :- City ............................................................. <br /> Contractor's Name ... ----..-_.----- <br /> ._.... ..... �...... <br /> . - ....... <br /> •� .............................Licertos tl��....7.1.,,..1........_. <br /> Installation will serve: Residence rtment House fl Cornmerda)QTratior Court 0 <br /> Motel❑Other <br /> Number of living units:---- - ._.. Number of bed. A.... ..........qdxeo Grinder .!�?.... tot Site ..................�,/ ©... <br /> ; <br /> Water Supply: Public System and name ............. .....: ......�...................51 ................................................Private Q. <br /> Character of soil to a depth of 3 feat: Sand E3 Silt Q Clay Peat Q Sandy loom 0 Clay Loam Q <br /> Hardpan Q Adobe 11 Materlot............if yes,................ ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be PkKed on reverse side j <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size.................. . ......................... Liquid Depth ................... ... <br /> Capacity --............I..... Type .................... Material...................... No. Compartments ...................... <br /> Distance.to nearest: Well ......... .......................Foundotfon ...................... Prop. Line...................... <br /> LEACHING LINE f I No. of Lines ---- --------------- Length of each finis................ <br /> ........... Total Length ......................... <br /> 'D' Box ........_... Type Filter Material ....................Depth .Filter Material ............................................ <br /> Distance to nearest; Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE t I Depth .................... Diameter .............. Number ............................ Rock Filled Yes Q No Q r <br /> WaterTable Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. tkrte ........ . ._................I <br /> Septic Tank (Specify Requirements) .................... ...._.. ... ...... . ........... ............ <br /> ..... <br /> �007 <br /> / / <br /> Disposal Field (Specify Reflu ements) ....-- .. .................:.. ..... ,/::ss,1...... <br /> ...-----•.............................. .... ....=J's, ..... .... ------...... ..... ................................................................. <br /> ------------------------- ------ ------------- ....... ------ ............................_............................................................................................ <br /> lDraw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work wilf be done In accordance with San loagWn <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heald DlsMo.Meana owner or hien <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is ism ofd, ! shadt`not employ any person in such meaner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ........ . .. ........ .... ... .... Owner <br /> ---- ---- -- --------- ��I)o'A­R­T­M­ENT <br /> (If other an owhti r) <br /> USE ONLY <br /> APPLICATION ACCEPTED BY ---- ------ - -- ---- .......................................................... .......... DATE .:° --,, �.— �. ......... <br /> BUILDINGPERMIT ISSUED - __ . .---- . --- • .................................................. ............................ <br /> .......................................... <br /> ADDITIO L OA MENT --- . .-_.._ ._... .._ ............................................. <br /> r l :. .................. .. <br /> ------ <br /> .- ------ --•----•-------- ----- - - --- ---------- • = .............................. ..... <br /> Final I spection by. -- .-.- - ---- . . ..... ............. ......•. ............ Date _ r ......_.._... <br /> �i 13 2!t 1-613 v 1?.........._ <br /> JOA IN LOCAL HEALTH DISTRICT $)� 3M <br /> r <br />