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6 r.w N%00 <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> - ---- ------- ----- --- ---------- ----- - -- ---------- (Complete in Triplicate) Permit No. <br /> - --- ---------------- <br /> ------ --- ----- ----- - ---- ---- --- - ---- ------ this Permit Expires I Year From Date Issued Date Issued <br /> Application is hereq made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This appumation is made in compliance with County Ordinance No. 549 cri&existing Rules and Regulations: <br /> JOB AD[5?ES&41 <br /> �OtATION - -- - ---- -- - ----------- .�_CENSUS TRACT -------------I----- ---- <br /> me <br /> Owner's 40 Phone --- --------- --------------- ----- <br /> ----------- ------------- ---- ------- -- <br /> Z. <br /> Address -------- ----- --- -------------------------�. City --------------------------------------------------- <br /> C ---- <br /> Contractor s Nar�e ------------------?---------- # ---- -- --'It--------- Phone ---------- ---------------- <br /> am �11 <br /> InstallatiV, willserve: sidenc4-E]Ap�Crtme)4 House mercial Trailer Court; :El <br /> AcrielD OJhe(------------------ ------------------------ <br /> ---- - <br /> Number living units-. um��3/,of bedrooms -=----Qarbage Grinder Lot Siie --- --------- <br /> Water SU,41 Public System nd nam ------------ <br /> ----—----------------------------- -------------------Private, <br /> -S�al to a depth 9T 3 feet. Son Slit F <br /> C)ay E] Peat 0 Sandy Loam [j`t Clay Loam <br /> Charade <br /> HI r pan E] Adobe Fill Material - --------- If yes, type------- ------------------ <br /> 6. <br /> (Plot plan„ <br /> showing size of to 11oJIc`r1- f �y stem in reldtion to wells, buildings, etc. must be placed on reverse side.) <br /> s e <br /> t <br /> NEW INS e nk or seepage pit pormitted if eublic sewer is available within A feet,)septic <br /> PACKAGEITREATMFNT SEPTItTANK 'Size,_XX---91_x1----------------------- Liqui�a q'pth __-,&----- - <br /> tff <br /> Gopacityz, 47-,___I- Type Material,&"W---------- No. Compartments --ern--------- <br /> -- ----.- Prop&Ine ------- <br /> Distc fmarest: Well.-_-- - ---------------Foundation -1:V__ -F <br /> LEACHII�,G LINE No. of6 A e�-------- --- Length of each line_/Ae*7_�------------ Total LehgtIAAe:V_ ------,------ <br /> D' BoN_ ,0_ Type FiIter/MateriaI0?T_1(_,5__.__Depth Filter Material <br /> --------------------- <br /> r-- --------- <br /> bw 4diston 6 nearest: We[ Foundation ------------ Property LiYle _- Q <br /> ----------- <br /> SEEPAGE PIT J 1D0th*1';g_//,:9 Di4eter/4.0-------------- Number ----------------- Rock Fill§d k1so No 0 <br /> A 7 14%t,� .Ie Depth --- ---------------------_Rock Size _1�7 -------------- <br /> Dis@n,e to nearest: Well Foundation Ze""e-------- Pro Line <br /> ,reat, _Vrl -------------- - - --------Foun -------- <br /> REPAJIP/ADDITION(Prev. Sonit4tion Permit# -___--. ...0---------------- --- - -- Date --------------------- ------------ <br /> r 1 <br /> 6 Septic Tank (Specify Requir t --------------------_-- ----------------------------------- <br /> -----:--------- <br /> m en s -`---------------=--a-- --------- ----------- <br /> Disposd Oeid=[S�A-VtReluireme -- --- -------:---------------------- --------------------------- ------- --------------------------- ----- --------------- <br /> ------------ ----------------- ----------------------------------------------------------- -- ------- <br /> ---------- ---- -------------- <br /> ---- -------- ------------------------ ------------------- ------------------------------- -- - -------------------- - - ----- - <br /> (Draw existing and required addition on reverse side) <br /> )L er ertify that I have Prepore <br /> V-4 this application and that the work will be done in accordance with. San Joaquin <br /> ' <br /> ounty -rclinances, State Laws,--cncrRules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> s d agents signature certifies',the following: <br /> certify that in the performiance of the work for whilch,thii �%%rLnit.,is issued, t Aull.not employ'any person in such manner <br /> I , r.�� <br /> r. <br /> as to become subject to Workman's Compensation lawr,'Abf California.,!, <br /> Signed --- <br /> - -------------------1�,_ Owner <br /> ------------ - -- ----- - --- ---- ------- --- - \ J��N 1. 1 --- <br /> er than owned) - <br /> By -- -----r �: ------ ------------- ------ ------ ------------- TItfP <br /> A(Ifoth <br /> FOR DEPARTtAENT USE ONLY <br /> APPLICATIONACCEPTED BY -- --- -------- --------------------------------- -------------------------- ---- ----- DATE------------ ---------- ------------- <br /> BUILDINGPERMIT ISSUED ------ ------- --------------------- ---------- -----------------------_------- -------------DATE ---------------------------.:..--------- <br /> ADDITIONAL <br /> ---------------------------_ --------- <br /> ADDITIONALCOMMENTS --------- ---------------- -------------------__---------------------------------- ------------------------------------------- -^-------_- '----------- <br /> - ---------------- --------- ---------- --- - .. --- ---------------------------- ------- ---------------------- <br /> ----------- <br /> ---------------1---- <br /> - - ------ ------- ------- - ---- -------- - - --:-;------------ ------------------------------------------ -- ---------------------- <br /> ----------- -------- ----------------------------------------------------------------------------------- -------- <br /> ---- ------------ ------ Date ------I ----- ------------ ----- <br /> Final Inspection by: ---------------------------- - - __ - vi�� ----------- ------ ---- -- 1:::f 7-H --- <br />