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APPLICATION FOR SANITATION PERMIT <br /> ............................. <br /> _ (Complete In Triplicate) arm . .. .... Z <br /> ..... ........ <br /> ...........I........................ :.. <br /> Permit No C:! <br /> .: <br /> .. This Permit Expires 1 Year From Date Issued Date Issued . 1......... <br /> Application Is hereby made to the Sara Joaquin Local Health District for a permit to constrict and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> t73 5^5 W 1 o� , <br /> JOB ADDRESSAOCAT N'� `� G <br /> ° NSUS TRACT .4..7�...�.� '�:r <br /> Owner's Na ...... � ............................... ! .......... ..Phone .....................................' <br /> Address .P .. .LpQ. -. ..__,...... city ..................... ...... <br /> . <br /> i/ ..... <br /> Contractor's Name --• _.__License #4 7 s l Phone! c 6 <br /> installation will serve, Residence OfApartment House❑ Commercial OTraller Court 0 <br /> Motel ❑Other............................................ <br /> W <br /> Number of Giving units:----- .. Number of bedrooms. ..._-..Garbage Grinder ............ Lot Size .. �.-Q......... ........ .....f�� <br /> Water Supply: Public System and name -------............................_....................w.................................................... <br /> PrEvats _ <br /> Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat' SandyLoam Q Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Material ........=If yes,type ......................:... <br /> !Plot plan, showing.-size of lot, location of system in relation to wells, buildings, etc. rnusube- placed- an reverse ide <br /> NEW INSTALLATION:. JNo septic tank or seepage pit permitted if vblic sewer is available w€thin"200 feet,} <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{ ize._��lr?,1�....J�./ ,�. .............. Liquid Depth ....7....... <br /> Capacity .�.Z�A. ... Type cfk�w_. Material- %4--.... _.No._.Compartments ..... <br /> '2 <br /> Capacity � <br /> S . ' <br /> ' :stance to nearest: Well' ... ��-`"" ........ Prop. Line II/"LJJ"77,��1I-A".•L�L�...++ <br /> ......................Foundation ...1Q.... �... <br /> ............ <br /> BEACHING LINE [ No. of lines .. Length of each line. /S" - <br /> .. .. Total Length ... .� <br /> 'D' Box .... Type Filter Material Filter Material ....Ile........... ....I.e... <br /> Distance to nearest: Well .....&,®....... Foundation . ., U.�........... Property Lime :SI-.Plm.J <br /> SEEPAGE PIT } } Depth .................... Diameter ................ Number ..................:t....... Rock Filled Yes ❑ No C fi <br /> Water Table Depth ................................................Rock Size <br /> Distance to nearest: Well ........................................Fosir,datfon .:............_..... Prop: Line ............... <br /> REPAIR/ADDITION{Prev. Sanitation Permit ........................................ Data ........ .........} <br /> Septic Tank ISpecify Requirements) ......................................... .........---.......---•.......».......:......----.........._. ......_...._.............: <br /> Disposal Field (Specify Requirements) ...........................-------•----•--...._.............................. <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 and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is issued, I shalt net employ any person in such an <br /> as to beComect to rkm 'su l Co1 ­1mpensation laws of California." <br /> :::gnec' 'r <br /> Owner <br /> By ............. . ' ... .. .................. . title .... .!.7............................................................. <br /> 'Of other than owner)Z <br /> FOR DIEPARTMENT'IISE ONLY t, <br /> APPLICATION ACCEPTED BY .. .�-�c.,,.�.. .. ..,... -•-.-- �.:.:....:...:....:.......�. ....-DATE ..../��.�. /�.".7�..:..........�.�. <br /> BUILDING PERMIT ISSUED ................................................. .DATES <br /> ADDITIONAL COMMENTS,_...,.--... <br /> -... ............. ...-........--.. ............._-------- ..--..... .................................................................................... .............. <br /> .. ............................................................. .... ..........�_-:': <br /> Final Inspection b <br /> p Y° - - /' . ate <br /> ............ ... ..... ... -- -�....-.... <br /> EM 13 21a 1-66 110V* y?i '� <br /> SAN QAQUIN ,LOCA! HEALTH DISTRICT 8/711 3M 5 <br /> � I <br />