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.t 'FOR OFFICE USE: <br /> {. SANITATION PERMIT <br /> � APPLICATION FOR SA y <br />,...... ........................ -.. ........... (Complete in T o. <br /> p riplicate) Permit <br />................... .. .. •............................. ;...t '. <br /> - Date Issued --- <br /> This Permit Expires 1 Year From-Date Issued'. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ......5. .,._.4�. J�.A� Aj.e..............•.........CENSUS TRACT <br /> a. <br /> Owner's Name ....- �- ---- lO1U- •---..;...•-•................................ ne _.. .. <br /> L .... Pho <br /> I U -•- . <br /> Address <5 74 f. . ... . :...... . 3:{ -Q- ....... city ........ :14<JaO lc�:-.... .........:.................. <br /> Contractors Name . ?. -..^ --=•,�•= �•-- tI`:.............License# Phone <br /> Installation will serve: Residence'93'A-Partment House Commercial ❑Trailer Court 0 <br /> Motel ❑Other -=_--- --- ----------=---•-...........- <br /> Number of.living units:............ Number of bedrooms ....Garbage Grinder .....---.... Lot Size ............................................ t <br /> Water Supply: Public System and name °... - _------•----•-•------•-•----------- - _......... - - Private�� <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑. Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hord ppn E] 'Adobeill Material ............ If yes,type ---------------------------- <br /> (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc. must ..be placed, on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,]_ t <br /> PACKAGE TREATMENT [ SEPTIC TANK.( I Size................................................ Liquid Depth ...............;.......... <br /> Capacity .. Type .. Material...................... No. Compartments ----.-----..........- in I <br /> Distance to nearest: Well-..................................Foundation ....................... Prop. Line .................. <br /> , <br /> ..... Total Len <br /> len _ . Length --------------------------- <br /> - <br /> LEACHING LINE [ j No. of-Lines :`::-='----•�{•-,••="= - gth of each line-------------------- -- - <br /> t <br /> D' Box Ty' al Filter Material ......:..... ...Depth Filter Material <br />{ Distance-to nearest: Well .......................... Foundation ------------------- Property- Line .................... <br /> SEEPAGE PIT [ ) Depth ..... .....--'E..._.- Diameter Number ------------ -------------- Rock Filled Yes ❑ No <br /> Water Table`Depth -..___--•---.4.............Rock Size --------------- ................ <br /> =-=== <br /> _ - , <br /> Distance to nearest: Wellt-..............-.........................Foundation .................... Prop. Line .....__--.-- .........r <br /> REPAIR/ADDITION(Prev. Sanitation`Permit�# ------------- •;-•••---_..Date ---•----...._--- ---- -. -----) <br /> �.• . , <br /> Septic Tank`(Specify Requirements) ------------------------ ............. .........................................-........................ ....i •-....t <br /> f I c t . ............... <br /> Disposal Fi Id (Specify cRequirements)..--= -40......--L' �P... ¢ <br /> - .---••.......................... ........................................... :.._ <br /> -------------- --------------------------------------------------------............. <br /> .......................... <br /> '(Draw existing and required addition on reverse side) <br /> I hereby certify that .I have prepared this`b.pplication and-that the work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local Health District. Nome owner or licen- <br /> sed agents signature ._certifie_s_the_following:, <br /> "I certify that in the performance of the work for which this• permit is issued, 1 shall not employ any person in such manner <br /> as to become sub'ect to Workman's Compensation laws of California." <br /> 'Signed ..... .....~,.....----.................................... Owner <br /> BY ----- ... .............•._...-__._..._-...............----- Title ... � c' <br /> If other than owner)i <br /> DEP TMENT .USE ONLY <br /> 1, <br /> APPLICATION ACCEPTED BY .. ...:e. = .....-•-•---'---._.. . DATE �-�-- ••�-� :.. <br /> BUILDING PERMIT ISSUED ............;.....- DATE <br /> ADDITIONAL C M ENTS ... ; •• •• <br /> ------------- <br /> 1.-. �, .....-.-© .: = :::::::::::::. :: ::::: ::::::: _:::::::: :::::::::::::: - ::::: <br /> ..-- ......-- .............. <br /> /.. �•------------------------ .......... •-----Da.e ��•�?h: . <br /> Final Inspection by: -:: rr. � : -------------------- <br /> .. .................---•.-_._..... . ........._.... s •-•-••• <br /> L!"' <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT <br /> G u 3.3}241.-Aa eo,, yet 72 3 ,K <br />