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tfi7ti C)ffi{E USE: v 7 Z �� ,' �f -�I <br /> ................. ..................................... <br /> APPLICATION FOR SANITATION PERMIT , '"'� <br /> (;Complete In Tdt llcatol Permit No. .7s:.�...... ? <br /> This Permit Expires I Year From Date Issued Date tauedl.I --------- S <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constiUd and install the work heroin <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> , <br /> JOB ADDRESSAOCATION A.S. I...J..p.a,#R4......)R/)----•------•......_f. ...... .? . .........CENSUS TRACT .......................... <br /> Owners Name .......4&w..Au–t.!_........ . i'ZZ.45.x.............. ............ .................. Phone <br /> Address . .... ...7! ` .. ,(. �!!�.. ............................. ._.. Cify .,�� ?............................... ... <br /> Contractor's Name ......---PN&.. ... ......6�P........License .... Phone <br /> Installation will serve, Residence 01A�artrnent House❑ Commercial QTraller Court 0 <br /> Motel []Other <br /> Number of living units:-.-;1._..... Number of bedrooms .....Garbage Grinder .1.%els. Lot Size .. .....l�4_!1':�� .............. <br /> Water Supply: Public System and name . ..............................._...................._......._.....----------.......----................Prhmte®— <br /> Character of soil to a depth of 3 Teets Sand b Silt❑ Clay o Peat Q Sandy Loam❑ Clay Loam <br /> IT, 7"Q/a Sort Hardpan l� Adobe❑ Fill Material ............ If yes,type........................... <br /> Mot plan, showing size of lot, location of system In relation to wells, buildings, ate. must be placed an reverse side.} <br /> NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( l SEPTIC TANKPQ Size................................................ Liquid Depth ....a. ............ <br /> Capacity�ZtOA..... Type eA1&iiF&-,1tr!cMaterla1...................... No. Compartments ..Q-----.........L}1 <br /> Distance to nearesh Well 1A,0/ .Foundation ZO...... Prop. Line ......w <br /> LEACHING LINE No. of lines .....,J.:............ Length of each line......#.,e............... Total Length ....1..A.0.'...........J i <br /> • as <br /> 'D' Box ....d...... Type Filter Material JA..............Depth Filter Material ..,<..r..'................................ <br /> Distance to nearest, Well ....... Foundation ....4le�............ Property lineZR.0:.?t...... i; <br /> SEEPAGE PIT Depth ... � 0 <br /> ....... Diameter _:!;I:�:!.`..... Number ........�................ Rock Filled Yes No � <br /> Water Table Depth ................................................Rock Size ...,�fA.*.::........... <br /> Distance to nearest, Well .'........................Foundation .... . ....... Prop. line ...e.P.."................. <br /> (REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ................................ .� <br /> SepticTank (Specify Requirements) ......................................... ............................................................._. ..........._............. . <br /> Disposal Field (Specify Requirements) .................................................. ................................................................................. <br /> .. <br /> i <br /> .. . ................................ ............_......-----...---------•---•----------......._.....-------------•--•----------................----.........._.....-----........-----..........--•-- <br /> .......................................................... ... ....................... .... ..---...............----.- .................................---•---•----....:....... <br /> (Draw existing and required addition an reverse side( <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San leaquln <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen• g <br /> sed agents signature certifies the following: ; <br /> "I ce ify at in the performance of the work for which this permit Is issued, I shall not employ any person In such manner : <br /> as to eco a sub ect to Wo k s an ensatlon laws of California!' <br /> 00p <br /> ai8ne _......._ .. i'r... ........ . .. Qwner <br /> B ... ----..... ... .. .............. ..................................................- Yale ........................................................................ <br /> - ([f other than owner! <br /> FOR DEPARTMENT USE ONLY <br /> r <br /> APPLICATION ACCEPTED BY .. ........................................................... DATE ........... : <br /> BUILDING PERMIT ISSUED ..... ... <br /> .. ................................ _._DATE-.:....................-----...---- <br /> r; <br /> ADDITIONAL COMMENTS ..._.. . .................................-.............. <br /> ... .................................................................................................................................... ................................... -------- 'A <br /> i <br /> . ...............................................................................................................--.......... ..........-. ....................... ... .E <br /> ..... ........................ ..._._.....'__ ....._.......� ._ ............ <br /> - F� <br /> Finol Ins ection b ............ <br /> Inspection Y ..,.................. Date .../ .�� <br /> EH 13 24 1-60 nov. -q( SAN JOAOUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />