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.t4Y" - <br /> t <br /> FUR GFf•ICE USE_- FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in Triplicate) <br /> r <br /> Date Issued <br /> This rotmit Expires 1 Your From Date Issued <br /> —. _— --- - - -J — <br /> v <br /> Application iS hereby mode. to ;I,­ ;,r:n Joaquin Local Health Dj,',ict for a permit to construct and ,nstall the work herein described, <br /> P< This application is made in comphunci with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS;l0 ATION CENSUS TRACT t <br /> Owner's Name r; _ �2 , 1�1�:..�.. ��( �+c�>7 e Phone .r1 .33:rC:. ... <br /> Address ✓� - 4- �l `�_ 1� • <br /> _ / .. City , . ??tl+t Zip .. ................. .. <br /> Contractor's Name -EG-2-?_c�� ,a7� �ce,ti/eC�� y�r^ . "�[� License 3• C Phone ; <br /> 1 installation will serve: Residence Q/ Apartment House n Commercial Trailer Court ❑ <br /> Motel Q Other. <br /> Number of living units: .. . . : Number of bedrooms :?".. .Garbage Grindew. ., . . .Lot Size.:,.. <br /> ei� Water Supply: Public System and name: .. . Private K I <br /> ....... <br /> a �- Character of soil to a depth of 3 feet:/Sand ❑ Silt Clay C] Peat❑ Sandy Loaoo <br /> Q <br /> Loom . Clay Loam <br /> Hardman Adobe❑ Fill <br /> I Material . . It y;S.type <br /> (pial Man, showing ,;zr. of =o% to-w;on of system in relation to wells, buildings;etc,must be placer' on reverse side.) <br /> NEW INSTALLATION: (No septic wnl- or seepage pit permitted if public s,wer is ovailoble within 2U0 feet, <br /> Px PACKAGE TREATMENT O SEFTIC/TANK [►1 Size �.r/�' ��%• Liquid Depth <br /> cLpacity A� V ..Type .tC✓)recce+ .:_Material ...,e4'7L• No. Compartments. 'Z <br /> Distance to nearest: Well . .. 5 �. ...............Foundation !O .!. . Prop. Line . .7_ r- <br /> ' LEACHING LINE [ No. of Sines ? ,. Length of each line... . d C Totol Length ... Jr�C.. �..-. . ........ <br /> 'D' Box f Type Filter Material.. .t'�,K.... Depth Filter Material . .....f.Q:...... ........ .... ... . ....... ... ...... .. <br /> Distance to nearest. Well J.d.e. '... .... .Foundation . ./ (� ,r..... .... ..Property Line . .,fir..-�. <br /> SEEPAGE PIT [I Depth 7 � r Diameter . ,���: �. - Number.. -3.. . ...-. . .. Rock Filled Yes No[] � <br /> Water Table Depth. ....C -1....................... ..Rock Size_ Y.- . ... ............ <br /> ........ r <br /> Distnnce to nearest: Well �..�-�'� '...... . ... . Foundation .. /,C _', Prop, Line .7`l.�...... .-:....� I <br /> REPAJR/ADDITION {Prey, Sanitation Permit#... . . .......Date...... ..............•.... .. . ) <br /> ,eptic Tank (Sperify Requirement.r <br /> .... ...........................• . ............ . ........ ...... ....... .........-... ... <br /> 'Disposal Field (Specify Requirements) .. . .. .. . i <br /> .............. ........... <br /> F ' <br /> S " <br /> r ............ ......... .... .. .. ........ ......... ... ... ........................I...... 1 <br /> t (Draw existing •quirel addition on raverse side[ <br /> I hereby certify t' ­r ua r pis • 301cation and I[Nof the work will be done in accordance with San Joaquin County <br /> Ord'nanrva, 5►- <. r• 1 2.. 1, end ttegulatiome of the San Jn-Yquin Local Health District. Mame owner or licensed agstttts <br /> ;S sign�tcrr rtrlfi^� • :r Foli..:wro: . <br /> "I certify that in th+ pe-frrm,.4r .^ r` tate work for which Inis permit is Issued, 1 shell not employ any person In such manner as <br /> }�7 to becor-- -orblect +o V'• -f' 's r ,mpensof-n low- of California." <br /> Signed. ..- . . "iwner <br /> By_. l��r_� <c14::sem. Title <br /> !-� <br /> r,,A_art <br /> FOP DtFARTMENT USE ONLY j <br /> APPLICATION ACC ] F �. � DATE �O �9' .7 <br /> DIVISION r`F L='+N:, j�uMRER DATE .. <br /> ADDITION^L COMMENTS <br /> Final Inspection by: Date �/�J'1� <br /> t" `� " 1/5AN JOAQUIN LOCAL HEALTH DISTRICT ►a5,2+ti" REV. 71 <br /> i <br /> ' � i <br />