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FOR-OFFICE USE: -K <br /> APPLICATION FOR SANITATION PERMIT <br /> -—----------- <br /> 1!�' <br /> -------------------I--------------------------------------------------------I----------------------- <br /> . pI <br /> Permit No.3 — X* ntiie <br /> ----- fThispermit Expires I Year From Date Issued ate <br /> Issued <br /> Application is�hereby'Lade to the Son 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. existing 549 and Rules and Regulations.. <br /> 0 R <br /> JOB ADDRESS/LOCATION _417149/--c---------------- ...... ... TRACT <br /> is ---------------- <br /> Owner's Name .... ---------------------------- ----------- ------- hone ------------------ <br /> Address ........../ <br /> A ity <br /> g-------------- ---------------- C ---------------------------------------- <br /> Contractor's Name �i� I <br /> ------- -----------License # ---------------------- Phone -- ------------------- <br /> Installation will serve: Resicleq�,A Trtrhent'Housef] Commercial' <br /> SO Vpa E]Trailer Court ❑ <br /> Motel E] Other ---------------------- <br /> Number i <br /> mber bf bedrooms -- ______Garbage Grinder 1eV-_e?._ Lot Siie',_�p -------------- <br /> N <br /> Wafer Supply: Public System and name Zt_J&' /1' ------------------------------------1�-----Private E] <br /> Character of soil to a depth of 3 -feet: And'E] Silt E] Clay El Peat 0 Sandy Loam f-1 Clay'Loam <br /> Hardpan F-1 Adobe A Fill Material ------------ If yes, type ------------------4____------ <br /> [Phot plan, showing' of lot, location of 'system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> I I <br /> NEW INSTALLATION: (No septic) 10 <br /> tan orseepage pit permitted if public sewer is available within 200 feet,) <br /> J 1 1 <br /> PACKAGE TREATMENT SEPTIC TANK-[ l Size----------------- ----------------- ------ ----- Liquid Dept <br /> CaDepth -------------------- <br /> patity ----- Type -------------------- Material----------------: No. Compartments ----------------- <br /> , ** �4 ''jAV <br /> Distance to nearest. Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> ov <br /> LEACHING LINE No. of LinesP I----------------------- Length of each line_______________________----- Total Length ---------------------------- <br /> VjD' Box ----------1-A(Type Filter Material ____________________Depth Filter Material --------------------•------------------=---- <br /> Distance to nearest: Well .------------------------ Foundation -------------------------Property Line ------------ ------ <br /> 4 <br /> -SEEPAGE PIT Depth <br /> -----------1 <br /> ------ lDiameter ---------------- Number ---------------------------- Rock Filled Yes E] No C1 <br /> Water .fable, Depth -----------------------------------& ------Rock Size ------------------------ - <br /> t Distance to nearest: Well ----------------------------------------Foundation --------------- ---- Prop. Line ---------­--­-- <br /> REPAIR/ADDITION(Prev. Sanitation Per4it# -------------------------------------------- Date ---------------.--•-•-----__---_-) <br /> Sept <br /> -------------- -------------- <br /> Septc Tank (Specify Requirements J---- ------------ <br /> -—----------------- <br /> Dispbscil Field [Spec r! e I or <br /> i yy. R 6 ------------0-0-------------------- <br /> qr.--I <br /> quiremerifs) <br /> ---------- <br /> -------------- --- ------------- --------- ------------------------------------------------- -------------------------------------------- --------------------- <br /> ----------------------------- ---------- <br /> ------------- ---------------.---------------- ---------- -------------------------------------- ------------------ <br /> row existing and required addition onlyeverse side) ---------------------- <br /> I hereby certify that I have prepared this application and that the work ons <br /> be done in accordance with San Joaquin <br /> Counpty Ordinances, State Laws, and Riles and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature cerfirli' thesf;Ilowjng: <br /> "I certify that in the performance of thework for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to�W&orikim an's.Cothpensation laws of California." <br /> Signed ---------- Z <br /> -------- Owner <br /> ---------------------- <br /> I <br /> ----- <br /> By ---------------------- ­ --------------------------------- Title ----- - ----------------------- <br /> (I e than ARTMENT—USE.-ONL <br /> APPLICATION ACCEPTED BY -------- ------ .1C ----- ------------------------------------------------------- DATE ------------------ <br /> BUII�VNG PERMIT ISSUED ------------ -- - ---- ---- T --DATE ---------------1 <br /> ADDITIONAL COMMENTS - ------------- ---- ------------------------------------------------------- ----2�-------­----------- <br /> ---------------------------------- - --------- <br /> --------------------------- <br /> Fin <br /> -----------------I----------------------------------------------------------------------------- --------------- <br /> - - --------- - ----------- ---- ------------------------------------------------------------------------------------------------------- <br /> ------------- <br /> --------------------------- <br /> -------------------------------------- -- ---- ---- -- ----- - ------------------------------------------------------------------------------------------------------------------ <br /> Fina,I Inspection by: ----------- -- - A-------------------------------------------------------------------------------- <br /> -- - -- -- - -- ----- ------------------------------------------------------------------ <br /> Date ------7,;� <br /> N QUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M, <br />