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FOR OFFICEYUSE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------ ------- -----------:----------------------------- V_ _ - Permit NO.. <br /> (Complete in Triplicate) <br /> ------------------- <br /> --------------------- --- <br /> Date Issued <br /> ------------------------I------------:--------------- This Permit Expires I Year From Date Issued <br /> N tai'_i*j 31 <br /> Application ii'K;F6by made to tK6__5a_n JEa—q-uin-�'L-o—ca-I'H'e-a'lfh-DistriZt-f6r'a 06rrnif`_t6­coristvuEt and-iih-sfall the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules'and Regiulations. <br /> JOB ADDRESS/LOCATION ---2;�_9 C7-'? ---- ----ORA N4�E�.�......... <br /> --CENSUS TRACT ----- <br /> 4 . 7' <br /> Z U1 <br /> Owner's Name - - ------------ 8,0 ------ ---------------------------------Phone �. ' <br /> Address --- ------ -6-N-4 - <br /> city ------li -------0 ------------------------------------------- <br /> Contractor's Name --------- <br /> W-mv ERI!- <br /> ------------------------------------- --------- ------Lidense,# ------_--------------- Phone -------- ---_---_ ........ <br /> Installation will-serve, Residencee<PE], <br /> artment House, Commercial F]Trailer Court I[} <br /> Motel F1 Other --------------E <br /> A ---------------------- <br /> Number of living units:_____(______ Number of bedrooms ��__,G'arb­c�ge Grinder IVP-- Lot Size -CR <br /> jEA_0,E--'t i ----------- <br /> s. <br /> Water Supply: Public System and name:--------- --------------------- <br /> -------------- ---------------------------------Private <br /> a e.. i <br /> Character of soil to a depth of 3 feet: �ancl'E:j\ Silt❑ Clay El Nat EI—Sandy Loom -E] Clay,"cam <br /> 4(a <br /> Hardpan Aclol�e-E] -Fill Material If.yes,type --------------------- <br /> (Plot plan, showing size of lot, locatioh ,;of system\in relation/towells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank 9r s epa e pit,pe'i'mitted if public sewer'4s available within 200,feet,)., <br /> I � a v 1 f <br /> PACKAGE TREATMENT SEPTIC TANK��, Size--- ------------------- Liquid Depth --------- <br /> \4) <br /> Capacity _MOj---- Type Sr'Material---lnP"C------ No. Compartments;...___ ------- <br /> istance to nearest: Well ----- ________________________Foundation ... ------------- Prop., Line.___ .:_ <br /> LINE No. of Lines ---- :17- ------------- Length of each line._�5_ :r---------- Total Length .......... ... <br /> 'D' Box <br /> Typed Filter Mater Filter Material ---t?-------------- ------------------- <br /> L- Distance to nearest:;Well -------5 Foundation --------- Property Line, r-57------------- <br /> SEEPAGE PIT I-,% Depth Jf-------------�Siarneter Number ------ -__.________.____.Rock Filled Ys WT-" No 0 <br /> ---------- _-0........ <br /> Water Table Depth _V­!�-------Z ---- ----Rock Sij!'w-0 <br /> V Distance to611 <br /> nearest: V�' -------------Mia ----Foundation --------- Prop Line ----- ------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --- -------------r.7n,____._________I Date ----f_`_____________________..1----- <br /> Septic Tank (Specify Requirements) ---------------- - .............—-------------I----------------------------------I---------------------- ---------------------------- <br /> '* <br /> Disposal Field (Specify Requirements) ---------- ------------------------- ------------------ -------------------------------------- --------------------------- <br /> ------------------------------------- --------- ------------------- <br /> ------------------------------------------------------------------------------ - ---------------------------- --------- <br /> t t <br /> ----------:--------------------------------------------------------------------- ------- ----------------------------------------------------------------------------------------1-1----------- <br /> (Draw existing qid required_"iied dddition on-reverse side) <br /> I hereby certify that I have prepared this application:and that the work will, be dome in a-cicordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Reguh3tians of the San Joaquiri'Local Health District. Home owner or llcen- <br /> sed agents signature certifies the following: <br /> "I certify th t in the performance of t work for which this permit is issued, I shall not employ any person in such manner <br /> ly �f <br /> as to bec e s9bject.-.t0#V`rkman's ompensation laws�okalifornia." <br /> OwnerSigne! - - -- - ----------------------------- --- ----------- <br /> By ----------------4�v <br /> - --------- ---------- -------------------- ------- ------------- -------------------- <br /> ------------------------------------------ Title --------- <br /> f &they than 6n owner)_ <br /> FOR RfkRTMENT-,,USE ONLY <br /> APPLICATION ACCEPTED BY ------t_�' ---------------------- <br /> --------- --------------------------------------- - DATE -6-e--------- <br /> BUILDING PERMIT ISSUED ------------------------------- ----------- ----------------------\ -DATE --------- --------------------------------- <br /> NTS - - - ---------------------- ----- ---- -------------------- <br /> ADDITIONIALCOMME' <br /> ------------------ ---- -------- --------------------------------------------- <br /> ------------------------------------ - -- ---- -- ------------ -- ----------------------- -- ------------------------- - ------------------ ------------------------- - <br /> ------------------------------ ------ -- --------------- ---------- -N%---- -- <br /> ---------- -------------------------------------------I----------- ----------- <br /> ----- - ---- - ----- --- ---- ------- ------- --------------- - ----------------- -------- <br /> ---------------- -- ------ - <br /> Fin I Inspec Date ---- ------------ <br /> a ----- ---- ---------- --------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />