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FC)R OFFICE USES APPLICATION FOR SANITATION PERMIT <br /> • Permit No. 7�.-••�•�f-� <br /> ..................................................... (Complete in Triplicate) <br /> .............................................. <br /> �-:'-•7r. <br /> This Permit Expires l Year From Date Issued Date Issued <br /> -� <br /> Application is hereby made to the San Joaquin Local Health District for o permit to construct and install the work herein <br /> described. This application is made in compliance y1th County Ordinance No. 549 and existing Rules and Regulations: <br /> i <br /> JOB ADDRESS/LOCATI _ c .67.. .....9 ••.�`�'�..•.-• ...CENSUS TRACE ....... <br /> Owner's Name ......_ ..................... .... ......Phone .................................... l <br /> Address ��-/�. .. City . i........................................................ <br /> Contractor's Name . !? -tea' / '�' `............License .fir -Phony ......:....................... <br /> Installation will serve: Residence[Apartment(louse o Commercial QTroller Court E] <br /> Motel ❑Other ............................................. <br /> Number of livingunits -_-•� Number of bedrooms Garbage Grinder ............ Lot Size ..•••................•... ....•.. <br /> .... ._` <br /> .._........•.....-f:.-.-.._....»._____»..----•----••---•...... <br /> Water Supply: Public System and name •--.----•-. ... .....Private <br /> Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay ❑ Peat 0 Sandy Loam 0--bay Loam 0 <br /> Hardpan Q Adobe❑ Fill Materlal ............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 ublie sewer is available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I I Size. . _1....e'-.45_i........ Liquid Depth ... . .... <br /> Capacity .10 cP!V Type --- .. Material� �C�....... No. Compartments ..rte.-........... <br /> Distance tc neatest: Well ...... .°.. ..................Foundation ... .--• Prop. Line .5./-t ....... <br /> LEACHING LINE [� No. of Lines .._.....rI:Z--------.._ Length of each line......... --4._--fes. Total Length .... '0.11t:....r <br /> 'D' Box ...i....... Type Fitter Material ......ol_. ......Depth Filter Material ...1_r1.. .................y...........W <br /> Distance to nearest: Well r <br /> ...._. _- ----j--- Foundation ------1--(�--�-------.- Property Line .... .................. <br /> S EPAGE T (� Depth ------./ -. 9ientetsrr �.._�t.116 Number ......:.I................... Rock Filled Yes [' No Q m <br /> Water Table Depth ......... 3-��•---- <br /> .... ••.................Rock Size ...f__/�...... <br /> Distance to nearest: Well .........'74-..x..................Foundation ....t.&_.�- `_. Prop. Line .......:�.---.-•--- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ..................I......................... Date .......-_:. -------_.---_.---) G <br /> - G <br /> SepticTank (Specify Requirements) ............................................ ......................................_...................................... .............� <br /> DisposalField (Specify Requirements) ........................................................................................•--...------...........................:...6 <br /> ......... ..................•-••---.....•.•......------.....-------••---..........................._........_......---•....._. •------•-•-•---- ---- -<­------------- <br /> - ..--.--.---•-------------------------------_.........---•---...._............._................_............................•....... <br /> (Draw existing and required addition on reverse side)- - — 4 <br /> 1 hereby certify that I 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 Health.D)strict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any person In such manner <br /> as to become subjectpensation laws of California." <br /> Signed .................... Owner <br /> By..--...................• to orkmon's Com ---- ---• --•----- Title . .............._._.._.. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.--- ».... <br /> .....................»............--......... DATE 6 � J "...�,�._......__._ <br /> BUILDINGPERMIT ISSUED ................................................... ---»...................................•---•-...•..DATE .. -- . ........_.................I_...... <br /> ADDITIONALCOMMENTS ..•...................................•........................... ---------- ---•..:......--•--....................................................... <br /> .................................. •-•••-••--.........,..-•-•-----•................----...._..... ..........---.......I.............................. ...........---..................................... <br /> �................I..................................... ................................................................. .......-•--............_....... ................................................ <br /> .......................................�5m <br /> . .......... �-+ <br /> .... <br /> Final Inspection by: ..._-. .....Date . .... .._ ..s2 <br /> EH 13 2t� 1-6£3 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />