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FOR OFFICE USE: <br /> a FOR OFFICE USE: AppL1CATION FOR SANITATION PERMIT �8`l©og' <br /> Permit No- -------- -- --- --- <br /> ---------------------------------------- f ri?j (Complete in Triplicate) <br /> q��j ! Date Issued <br /> ------------------------------------------------------ <br /> ---------- ----- f o�' <br /> Y' This Permit Expires 1 Year From Date Issued <br /> stall the Work herein described. <br /> uct and in <br /> Pp <br /> A lication is hereby made to the San Joaquin Local Health DisNot Torr q permit existing Rules and Regulations: <br /> This application is made in compliance wit County Ori nce o <br /> 1 <br /> EN -- ----------- <br /> _ - SUS TRACT. - -.-.. - <br /> JOB ADDRESS/LOCATION__-__. __--_ Phone_ 0 <br /> ,4 I eta- <br /> --------------- <br /> Owners Name SG�� - -------------- <br /> 00, <br /> r lIC� - <br /> Address 6 '�cf ' - F , - �- <br /> Contractor s Name-1 --- .►------ ---- <br /> --------------- <br /> ------------License # ------ � - �---- Phone ------ ----- ------ ------- <br /> A artment use El <br /> Trailer C urt Elinstallation will serve: Residence E] p <br /> Motel ❑ C.� W <br /> - , Other-- - ----- <br /> g ------- ----- ------ ; <br /> Number a# living units:_- --- Number of bedrooms._-_.-----_-Garbage.G.rind`er't- - Lot,Size_-._."-__---- <br /> R. <br /> ------------------------------- <br /> --------------Private ❑ <br /> Water Supply: Public System and name._..----- -,- ----�------ -y ,� ,e <br /> Character of soil to a depth of 3 feet: Sand Silt clay Peat [::X Sandy Loam ElClay Loam ❑ <br /> Adobe ❑ Y tYP <br /> ., Hardpan ❑ Fill Material_---__ .If es, e_._'?---------------- <br /> erse <br /> Plot Ian showing size of lot, location of system in relation to wells, buildings, etc`;must be placed <br /> n 2ev feet side <br /> [ pble <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewe� is va <br /> PACKAGE TREATMENT [ 1 <br /> SEPTIC TANK [ l <br /> Size 4240-- --------------.-Liquid Depth.---------- <br /> Capacity------------------ --Type--------------------- Material. --------- :Y`-No. compartments._: - <br /> (� FoundationIffProp. Line_ - <br /> Distance to nearest: Well_- <br /> ------- <br /> -_ o a <br /> � 1 . r <br /> Length of each line --:- -,= Q-=- -- -=---.Total.Length._- �-- ---------------'------- -- -C <br /> LEACHING LINE I 1 No. of Lines-----/---------------- g / j 1 --- -----------_. <br /> D' ------ <br /> Box_- ----..Type Filter Material-t '. epth Filter Materiel_.--- / r <br /> -- --------- <br /> ' Distance to nearest: Well_-_ Q =------------Foundation---_-- - ��-M- t- ---.Property Line--- ---- s - ---------- <br /> ----- <br /> �.�t PIT [ ] Depth------ -------- Number : . - : <br /> x Rock Filled Yes ❑ No ❑ <br /> S Diameter-------------- -- -- <br /> Water Table Depth -------------- -- ------ ------ ------- ------ryRock Size- <br /> 1 ----------- <br /> Distance to nearest: Well---------------------------------------------Foundation--',_---.-"----------"-- Prop. Line <br /> ------.Date--- ----r-------- ----------------------- -) <br /> REPAIR/ADDITION (Prev. Sanitation <br /> Permit#__--_-.-_.------------ -- fi <br /> - -------------- = C <br /> Septic Tank+(Specify Requirements)-----------•------------------------- <br /> - ------ <br /> { 1 s +-_� -__"--*_.-__-•-teras_--f'------------------------------:---------_.--_--.----__-__---__-. <br /> Disposal Field (Specify Requirements)---------------------- ------------------------------------ <br /> ------------- <br /> i * --------------- --- --------------------------- -------------------- <br /> ------------------- <br /> -•------------- = �`` <br /> _________a------------------------------------------------------------ <br /> ------------------:---------- <br /> s (Draw existing and required addition on reverse side) <br /> i % 1. <br /> he work <br /> ance �v <br /> I hereby certify that I have prepared this appl'�gtionson noft the hat tSa Joaquinll"LocaldHealth Dist itfione-in d.' Home owner orJlicens d agents <br /> Ordinances, State Laws, and Rules and Reg <br /> •4 <br /> signature certifies the following: <br /> "I certify that in the performance of the .work for which this permit is issued, I shall not employ any person in such mdnner as <br /> to become su lec to ork9+an's Compensation laws of California." t <br /> '� ' --Owner <br /> Signed - �� - = <br /> --- ------ <br /> Title-------- ---------- r <br /> i BY-'----------- <br /> (lf other than.owner) <br /> ,FOR DEPARTMENT USE ONLY <br /> DATE.� -s r <br /> APPLICATION ACCEPTED BY----=- °y <br /> QIVIS#ON OF LAND NUMBER--------------------- - <br /> ------------------------------- - <br /> -------------- ---------------- ------- <br /> ADDITIONAL COMMENTS_------------------ - - ----- - <br /> ---------------------- ----- <br /> --- - <br /> --------------------------- <br /> ------------- -- ------------------------------------ <br /> - - ------ <br /> --------------------------------- -------- ----- <br /> art�r- ------- ---- �-- -------- -----------------------------------Date--'--?- •- �---.- <br /> Fina# Inspection by: / SAN JOAQ F&5 21677 REV.7/76 3M <br /> � EH 13 24 <br /> �� UIN L CAL HEALTH DISTRICT <br />