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FOR OFFICE USE: H <br /> AMICATION FOR SANITATION PERMIT <br /> ........ .. . �— tCon►plete in Ts3pllcdfe) c.. Permit,No. __ <br /> n This permlt expires <br /> ]:Year t Date issued datrr`Iasued . .... !, <br /> Applic ti�ia ~as hereby made to the-Snn3loaquin Local Health District for a perrni#oto nstructknd Install the Work fterein <br /> deserib d.Vhis application is made in compliance with County:Ordinance,No._,,549.'andyeilitinules and Regultition`s�� <br /> f; <br /> A DDRESS/LOCATIO~N+.......-----...... <br /> A .. <br /> JOBAt <br /> ............................t• = ' ."F- ...... : - . -« <br /> $ TRACT II <br /> ...................................................:.....................Phone .... <br /> 4 <br /> Owner's-Name i •• 1, <br /> Address ............................. city 1 <br /> 40 <br /> Contractor's Name _._... ................. License ........... Phone; - <br /> A � _ <br /> 60 <br /> Instollation will serve: Residence Apartment House Commercial ` { t <br /> p fl ]]fralier Court 13 <br /> t Motel []Other--------------------•••-•--................. 4f f Yj <br /> let <br /> Number of living units:_..------__ Number of bedrooms Garbo a Grinder Lot Size �` '� [ _.=.E t �1 <br /> Water Supply: Public System and name ................•-....--_.................... .. .........._................ . Pficrfek x,;f . . . <br /> i - <br /> Character of soil#o a depth of 3 feet: Sand E] Silt 0 Gay [3 +"Peat 0 Sandy Loam fl Clay Loam 07*- <br /> `- <br /> s 0)4 s : 1 I, Hardpan{] Adobe❑ Fill Material ............ If yes, pe..........:.. ... w . , <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be plated"on" reverse <br /> NEW INSTALLATION: (No septic tank or seepage pit .permitted If public sewer is available within 200 feet,) _ <br /> PACKAGE TREATMENT [ 1 SEPTIC TAMC ] ` 4 r <br /> d Depth <br /> .:�.�..'..:............. <br /> Size:...----•------................................ Liquip <br /> ••• T e -------•-...--.-- _.hAa#erlal.. '. ' #. <br /> �. Capacity yp 1' .. No. Com artm its . <br /> Distance.to nearest: Well ...............•......,..............Foundation ..........._..._.....Prop`-'Line __...........:........ <br /> t- -� <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line._....I................. Total Length ....................... <br /> d' Box .........._. Type Filter Material=...................Depth Filter Material <br /> I , <br /> ' -Distance to nearest: Well•...:......._. Foundation Property Line' ......... <br /> „r, <br /> SEEPAGE-PIT { ] Depth ._.__*---------------Dicim6fer .._.__..._ Number ............................ Rock Filled Yes No �. <br /> Water able lae <br /> +•' T -..._ ..Rock�Size ..............._.. <br /> ' • Distance to nearest: WMf :'- �' -� �. <br /> ..................•----.: Foundation .....-•-•----•------ Prop: Line . .. <br /> � ' y <br /> REPAIR/ADDITION(Prev. Sanitation PBrmlt# ...... �...:-_-• Date ..................................1 r ; ... ,t <br /> 1,S6 •tic Wank. S Requirements) ` . . , ._. <br /> eci <br /> p ( p fy Re ........ —.-•--•--•••••..... .. .................. <br /> q <br /> ;Disposal Field [Specify Requirements] <br /> ............ .....• -----• ------•----- ......... ........... ....................... <br /> ---•---•----------- -----------•-•------ <br /> l �,l (Draw existing and required addition on reverse side) <br /> I here6yjertify th ht I have prepared this application and that the work will be done in.accordance vlrHh,S.�an�Joaquln <br /> County Or`dlnances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Distritt. Homeowner ar lidera <br /> sed agents*signature certifies the following: <br /> "1 certify that in the performance of the work for'which this permit is issued, I shall not employ any person 4-1-such manner. <br /> as to become subject to Workman's Compensation laws of California." �� <br /> Signed'.__ _- -._ i--'----------- ------------------------•-•--- Owner <br /> B <br /> Y f ' + €Mother than owner <br /> I---------------------- <br /> --- --------------------- ---- Titre ..------------------ .........................._ f J� <br /> ". ►. FOR DEPARTMENT USE ONLY <br /> APPLICAT,ION-ACCEPTED BY ----• ---------------------------....••----------------- .._..----. ...... DATE ._ ----------•------------ ...*.: <br /> BUILDING PEitMIT ISSUED -------------- <br /> -----------_-------------------_- .........._.DATE ....._.... ...................... '- <br /> ADDITIONAL COMMENTS ...................:........................................ <br /> _- . <br /> t : <br /> ..._:.....-.__... <br /> • = <br /> ­--------­------- <br /> ............... ---- _..__.... ------------------------------------ <br /> FinalInspection by. --------- ----------_--------- ------ ........................ ...............................----------------Date _. ......................................... <br /> EH 13.2h 1`68 Rev. 5m SAN JOAQUIN LOCAL HEAETH DISTRICT 8/7h� 3M <br />