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Al <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. . <br /> J <br /> i <br /> ..... .. This Permit Expires 1 Year From Date Issued Date Issued ._.' <br /> d Application is hereby made to the Son Joaauin local Health District for a permi' to construct and install the work herein f <br /> described. This a;;Ylicc:irn is made in corrphonce with County C-dinc,nce No. f49 and existing Rules and-Regulations: l <br /> JOB'ADDRESSAOCATION . /�r�`�'..."r 'tl=�!��..:_�t�.� > �C. CENSUS TRACT I' <br /> -, <br /> v r ,, <br /> Owner's Name 1� i>z s! ,c'-xurrcl�/- �..__..... :.. . ............. .-. -Phone .. 1 <br /> Address . <br /> Cij r z <br /> -- ......._./' c'.. ` .. ty c- <br /> Contractor's Name. 't '.. �Cr .,,.��.. {lc �_License #:� X S .�:'.. Phone . <br /> i <br /> Installation will serve: ResideoceApartment House❑ Commercial[]Trailer Court [! <br /> t <br /> Motel <br /> Number of living units: / Number of be r oms_....._..Garbage Grinder Lot Size ..... <br /> Water Supply: Public System and name .,... . ........... ..... ---_.. ........... ...............Private <br /> Character of so i!to a depth of 3 feet: Sand ❑ Silt[j Cloy ❑ Peat❑ Sandy Loom y toom [-II <br /> Hardpan❑ Adobe E Fill Materiol . . If yes, type . <br /> {plot plan, showing size of !ot, location of system in relation to wells, buildings, etc. must be placed on else <br /> i <br /> NEW INSTALLATION: (No sept'c tank or see le pit permitted if oubllc sewer is available within 200 feet,) <br /> f ) � / '� Liquid Depth . ...,.......... I <br /> PACKAGE TREATMENT SEPTIC TANK t Size . .. r. '..., ..:�.._... .._ . <br /> nts <br /> Capacity •1 -c'c' '] Hype{f��t ��.,�. Material- ir�C'. No. Corn pArcmeLine .Y.� ...i........ 4 <br /> SJ V +. Length �- ,-c� <br /> Distance to neare f: W.11 5 .. ..............Foundation .. 1 C` -S <br /> LEACHING LINE r No. of tines Length of tach line e' Total Len th �......_. <br /> D <br /> L. Jt. - [ <br /> 'D Bax Type Filter Material /C:.... .Depth Filter Material ..../..1� �i <br /> D;,-unr_c 1 nearest: V'lelf ... .:Sc' . Foundation ��'. ` Property Line ........................ <br /> SEEPAGE PIT [ J Depth Dion}eter Numbe- Rock Fiiied Yes ❑ No CJ <br /> Water Table Depth ..Rock Size .. . .. ................ <br /> Distcncc to nearest: Well _. - .,..✓oundation Prop. Line .............I.,...... <br /> REPAIR/ADDITION(Prrv, 5aniicllon Permit # . . ...: Date . ....... ........ <br /> ) j <br /> Septic Teink (Specify Pe.gi)irementsl '( <br /> 'y <br /> Dispo:;al Field (Spec. fy Requirements) ............. . <br /> F, <br /> 4Draw existing card required cdci&cn or} reverse side) f <br /> I hereby certify that r have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Frcail6 District. Home owner or !leen- ' <br /> sed agents signature certi'ies the foilowing: <br /> "I terrify that in the performance of the work for which this permit is issued, I shall not employ,any person in such manner <br /> as to become s�b act to Workman's Compensation !avis of California." <br /> Si3nCrl �� C� 't Owner <br /> r,r _ �L-•7+�: .�� `;f- <br /> FOR DEPAPTMENT ',)SE ONLY j p <br /> i t'l, ':!,';(`;•i �'CC i'iF 6'. � ���r2Cr�� DATE <br /> ifDlr•!G ? Lr .�1 ]SUc".r . ATE . <br /> fM1 <br />