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FOR OFFICE USE. <br /> ....... ------ APPLICATION FOR SANITATION P00IT <br /> ---------------------------------------- 'Complete in Triplicate)--------------- Permit No, <br /> ----------- ------------------------------------------------ This Permit Expires I Year From Date Issued Date Issued ----- <br /> Application.is hereby made to the San Joaquin Local Health District for a perd ie work h <br /> clescribe�d.,'This application is made in compliance with County Ordinan mit to construct anti Rulesnstall andthrein <br /> Regulations. <br /> JOB ADDRESS/LOCATION -30e_;7 / -n" .. V <br /> _0,17------------- ----- TRACT ----- <br /> Owner's Name ------ Phone ----------•----------- ------------- <br /> ------------------------------ ----------- <br /> Address ---------- <br /> -------- city <br /> Contractor's Name ------------ ---------------------- ------------------ <br /> I ______.License I Phonei;;K <br /> Installation will serve: <br /> Residence XApartment House-E] Commercial ElTraller Court ❑ <br /> Motel [I Other ------- <br /> e, <br /> Qr <br /> Number of living units:_ ---- Number of bedrooms ------Garbcige Grinder -ZY4!5�' Lot Size -5 <br /> Water Supply. Public System and name -C , <br /> —--------------------------- ---------------------Private ❑ <br /> Character of soil to a depth of 3 feet. Sand 0 Silt 0 Clay <br /> El Peat 0 Sandy Loom ❑ Clay Loom <br /> Hardpan El Adobe;X Fill Material ------- If yes,type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEP TICTANK�x <br /> ---------- - Y <br /> —9!Liquid Depth ------------ <br /> - <br /> Capacity Type/a-r/--<---:<�� Material ---- No. <br /> Distance to nearest: Well ------- 11 <br /> -----------------------------Foundation --4�7----------- Prop. Line -- -—------------- <br /> LEACHING LINE No. of Lines -----/______________ Length-of -each <br /> --- --- Total Length <br /> ........... <br /> 'D' Box Type Filter Material ep;th Filter Matofibl <br /> ................... <br /> Distance to nearest. Well --- <br /> r-----—------ Foundation �Property <br /> --- - --- Line <br /> SEEPAGE PIT --------- <br /> Depth -X-60—------- Diameter %-V-47----- Number ------- k Fi led Yes No <br /> Water Table Depth --- -------------------------------- €z <br /> Distance to nearest. Well ------- <br /> --------------------------------FoOnclation -f---- ------- <br /> Prop. 'Line ------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- —7------- Date ---------'-----------•-----------_) <br /> Septic <br /> -------- ----------- ------------ <br /> Septic Tank (Specify Requirements) ------------------ ------------- <br /> % ------- - -- ---------------------------- <br /> ----------------- <br /> I - --------------- <br /> Disposal- Fi Id (Specify Requirements) ---- 15'44r-- - <br /> ? .,o------------ -�-------------------------------- <br /> ----------------- ------------- <br /> --------------------- --- ---- <br /> ------- --------------------------------------------- <br /> -------------- ----------- <br /> ---------------t. <br /> -------------------------------------------------I--------- <br /> (Draw existing and required addition on reverse sjdee <br /> I <br /> I hereby.certifil that 1 .h6ve prepared this application and that the`v6Wwlill be 4&46-1- <br /> n accordance With Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that iiii the performance of the work for which this permit is.issued,;l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation sof California:" <br /> 31P <br /> Signed ---- ------------------------------ ---- -------------- !�(F <br /> - ---------- ----- ;v,-------— Owner <br /> By ------- ------- ------ <br /> ----------- <br /> il�e-r--t-h'--a----- ned ------- Title --------- <br /> (if o ���y�' <br /> (If <br /> USE ONLY <br /> APPLICATION ACCEPT <br /> ------ ------------------11-------------------- DATE <br /> BUILDING PERMIT ISSUED ---- ---------- -------------------- ----------------------------------- --------------DATE --- ------- ........ <br /> ADDITIONAL COMM T , --------------------------------- <br /> ---- -- -- -- --- -- --- - ----------- --------------------------------------------------------------------- --- ------------------------- <br /> ----- - I ------------------------------------------------------------------- ---------------------------------------------------- -- <br /> -------------------------- -/A------- <br /> ----------------- - ------- <br /> ----------------------w------------------ - -------------------------------------------------------------------------------------------------------------------------- <br /> Inspection by: ----- ------------------------------7--------------------------------------------------------------------------------_- <br /> Final - <br /> ----- -- --------------------------------------------------—-----------Date <br /> -61'�------------- -- --- ------- <br /> SAN JOAQUIN CO <br /> CAL HEALTH DISTRICT <br /> E.m.H. 9 1-'6 Rev. 5M <br />