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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No- <br /> (Complete in Triplicate) <br /> -------------- <br /> --------------------------------- ----------- Date Issued <br /> .%, ----------- this Permit Expires 1 Year From Date issued <br /> IF, <br /> Application is herebymade to the Son Joaquin Local Health Districtfor a permit to construct and install the work herein <br /> described..This appQcation is made in compliance with County Ordinance No. 549 andexistingRules and Regulations.. <br /> JOB AD[J'FEss,�tbtATION -------------------------------------- -----------------I----.__X__CENSUS TRACT -------------- ------ <br /> ------------- --Phone - <br /> n �r <br /> me ------------- <br /> 4- <br /> _7 <br /> Address - ----------------- ;7 <br /> -ity 7 ------ <br /> --------------------------------------------------- <br /> ------------------------- C <br /> ---------- -------- <br /> Contractor s Narv'e --------------------- License ------i`------- --- Phone ------------------'----------- <br /> [ lnsfiallatio '11 A <br /> wi serve: Reside e,- 6t House Commercial Tra er Court�,,E] <br /> pdrtme <br /> oe r --------------- ---r-e' <br /> , 1 7 qj-hq/ <br /> ------------------------- <br /> Number of livi!ng units:___��i--- Numberr of bedrooms __=_____qarbage Grinder -—-------- Lot Siz.e ------------------- <br /> -----------Private <br /> Water S4ply:., Public System and name' ------------ - <br /> r^ <br /> I---------------------------41�-------- <br /> --------------------- if F 1:4 . '0 <br /> C Peat ❑ Sandy Loam .0'6 Clay Loam E] <br /> Character'bf soil to a depth 9f 3 fee Son I 5iit Fi ay D <br /> p"a' n D' Adobe-L] Material ------------ I <br /> HprY Fill M' f yes, type --------------- <br /> pldced on reverse side.) <br /> (Plot plan,, ing size I oJ i o nN of stem in re[,6tion to- wells, buildings, etc. must be% <br /> bhow <br /> NEW INSTALLATION: (No septic tank or seepage pit pdrmitted if Fublic sewer is available within 2d0 feet,) <br /> PACKAG SEPT iC�TANK 'Size- ------------------------ Liquid .15ppth -- -- ------------------ <br /> No. Corn�partments ---Z�n-------------- <br /> d a p a c ity Type Material,& <br /> Distance,%a_ nearest: Well 60_F________________--Foundation _79---------------Prop- 6 ine <br /> 'G LINE ------------- <br /> No. of fli n els! - ---------- Length of each line-/ <br /> Le, --- <br /> LEACA --------------- Total h g i <br /> 'D' Bob-W__A Type T i Ile r/Materi a I Depth Filter Material ---------------------------- <br /> 4&istance to nearestY Weil ----------- Foundation ------------ Property -------------- <br /> -4— <br /> SEEPAGE PIT iDepth Rock Filfiedl ,L�,e s NoC <br /> D i 68 titer r ---------- Number ---- - ------------ <br /> Depth ----------- -----------------------Rock Size <br /> DistOn to nearest: Weil --------------------------Foundation /_/��Ao-------- Pro tine _�a�----------- <br /> ---------------------------------- <br /> REPA[L/ADDITIION(Prev. Sanit&;on Permit -------------------------------- Date <br /> SepticTank (Specify Requir4menfs) ----------------------A------------------------------------------------------------------------------------- --------------------------- <br /> :--------P-DiPosa --F--i-e-�-W--z- <br /> s�­tk <br /> y.%�-L-R--e-- -u--i-r-e--m---e-- <br /> - ----------- { - ' <br /> --------------------------------------------------- <br /> --- <br /> _ IL ---------------------------------------------------- <br /> - <br /> I------------------------------------------------------------------------------------------------------------------ -------------- ------------------------ <br /> k__'A ------ <br /> (Draw existing and required addition on reverse side) <br /> Ihe�r;�P'*y ertify that I have:o�t6erekl this application and that the work will be done in aecorclance .with.,San Joaquin <br /> Vik)� 1$ me owner <br /> rdinances, State La�_v_i,_`6'n_ZRuIes and Regulations of the San Joaquin Local Health Di trict. Ho or licen- <br /> spd agents signature certifies the following- <br /> ie'rtify that in the perforance of the work for w <br /> performance hi-chjhli p'�rmiti <br /> -,is issued,), lh4�11'L.npt employ,any person, in such manner <br /> asN - <br /> tc�become subject to Workman's Compensatinn law,ebf,Cali ifdrnia. <br /> Signed ---- ---- ------------------ ------ --------------------------------------------- 0.w n e r'%, V� <br /> By ----------- ------ -------------------------- <br /> -------------------------------------- --------- Title ��4i� �11 <br /> (If other than owner) <br /> FOR DEPARYMENT USE ONLY <br /> " --------- --------------------------- <br /> APPLICATION ACCEPTED BY ..... ------ ------------ -------------------------------------- DATE <br /> - <br /> BUILDINGPERMIT ISSUED ----- ---------------------------------------- ------------------------------------------------- -------DATE -- --------------------------------------- <br /> ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- <br /> -- <br /> ------------------- ---- - -- ------------------- - - ------------------------------ -------------- <br /> -- ----------------- ---------Z ------- <br /> ---------- ---------------------------------------------------------------------------------­--------------------- -77 ------------ <br /> ---- --- ---- ------------ ----------- af� ---- ----0 <br /> - ------ ------ ----------- -------------------------------------- ---------- --- -- ---------------------------------------------------------------- ---------- <br /> 1-4 -Z, - /��/ -�._ - <br /> FinalFinal ------- --------------------- <br /> Inspection by: ----------------------- ------- --------------------------------------------- --- - -- ---- ---------------Date <br />