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.; -.4. <br /> i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> . .. <br /> -....-... - Icemplete in Triplicate) Cat_ <br /> \ <br /> .. .. ..... . \ <br /> -. .._. - This Permit Expires 1 Year From Dats Issued <br /> . . .. <br /> ,act id install <br /> Application is hereby made to the Son Joaquin local Health District for a permit to tcnstc <br /> described.This application is made in compliance gwith County Ordinance No. 549 and existing Rules and R° <br /> q astP <br /> EN` S TRACT . <br /> JOB ADDRESS/LOCATION OSS ` - -- - <br /> " p one <br /> Owner's Name ( <br /> Address - b <br /> •�' -� "^'!_Phone <br /> —o <br /> Contractions Name ... license# <br /> Installation will serve: Revlon a eAportment House Q Commercial QTrailer..ours ❑ <br /> Motel Q Other ............. .............................. <br /> _ . -..._.. ... _ <br /> ,. _.. <br /> Lot Size <br /> Number of living units:. ..... Number Number of bedrooms -.3.....Garbage Grinder <br /> " Public System and name .. .. . ......... <br /> ............. <br /> .... ..... .. .. <br /> Water ter of y Clay Q Peat El Sandy Loam Q CIO Loch <br /> Character ofsoil to a depth of 9 feet: Sand❑ Q Fill Material .. .. . ... If yes, type .-- -- _ <br /> Hardpan Adobe [I <br /> t showing size of lot, location of system in relation to wells, buildings, etc. must be place) <br /> NEWplan, - <br /> N µ/INSTALLATION:� (No septic tank or seepage pit permitted if public sewer �. available Liquid Depth•._ - <br /> SEPTIC TANK[ 1 Size........................... ... <br /> PACKAGE [ I - - - <br /> Capacity .____..__._ Tyne .................... Material...................._ Na. Compartmen!• ' <br /> Prop <br /> ............. <br /> Foundation - - --��� - -- <br /> Distance to nearest: We -- •---.--- <br /> No, of Lines - .. ..... ... <br /> Le,-,9th of each line...---- <br /> LEACHING <br /> ine -- - <br /> Total eryr•� -- <br /> LEACHING LINE [ I .Depth Filter Materiol - <br /> 'D' Box ..... Type Filter Material ................. - <br /> e.' Property Lin. <br /> Distance to nearest: Well . ...................... Foundation ._... - <br /> .. ............. <br /> t' Number . __ . . .............. Rock Filled <br /> Depth Diameter <br /> SEEPAGE PIT [ J e' - <br /> . . . . ....... <br /> Water Table Depth .......................-....._ ..Rock Size ........................... ... P.rep. i,.. ......... J. <br /> Foundation ......... <br /> • Distance to nearest:Well ..._......................._........ ....__......_...) <br /> REPAIR/ADDITION(Prey Sanitation Permit# ............................................ Date ...__._.._. . <br /> septic Tank (Specify Requirements) ._...._....................7..�........_-. <br /> a Requirements) ..- •-.�.•a'..e.� <br /> Disposal Field (Specify <br /> or...... d....3 ..-..- ............... <br /> - Z...h-:.,a.._..... ----- -.................._...._._. <br /> ---� .....��------------- (Draw existing and required addition on reverse si a .n Joa urn <br /> 1 hereby certify that I have prepared this aPPlieation and that the work will 6x done in accordance q <br /> County Ordinances, State Laws, and Rules.and Regulations of the San Joaquin Local Health Dist <br /> h. iicen- <br /> .�.er or <br /> ermit is Issued' 1 shall not umploY any Per'- +^ ,�ch m•�n acr <br /> sed agents signature certifies the following: <br /> ,? "I certify that :,the performance of the work for which this p <br /> as to become subject to Workman's C ensation law of alifarni. <br /> Owner <br /> Signed Si ......_..- <br /> g .-... .. ... ... ... �. � -. _.. .._. . -. <br /> .... -. Title ..... <br /> By- ilf other than owner) <br /> %- FOR DEPARTMENT USE ONLY <br /> _.. <br /> DATE <br /> _A E <br /> APPLICATION ACCEPTED BY DATE <br /> BUILDING PERMIT ISSUE -- "" - - - -- <br />