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4 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMITr'< <br /> ..........:...,,................__._......__ <br /> (Complete in Triplicate) Date it Is <br /> _: This Permit Expires 1 Year From Date Issued "t <br /> 4 <br /> f Application is hereby made to the San Joaquin Loccl Health District for a permit to construct and install <br /> described. This application is made in complicince with County Ordinance No. 544 and existing Rules ond''r <br /> JOB ADDRESS/LOCATPON :.:. . ..�5.- ..... . ....:JY.W :-...� :::._...... :.. .: . CENSUS TRACT <br /> Owner's Name ....... � � i_7.�.. t? ... <br /> �y Phone .: <br /> h ,. :AddressC....:'f-L('W - 1.G.� . ..._ ....city �t1T.E:14 <br /> C.mtractnr's Name-0,L IhI :.......... .......................... <br /> ...._-...License tit' .:... _ . . ........:Phone ...... <br /> ins`allotion will server Residence�a�rtment House Commercial "railer C^ud C! <br /> Motel []Other _... ...... ......... <br /> � es t <br /> Nurrb�r of 1lving units: :. ..: Number of bedrooms- -r....Garboga Grinder - o, Size „'• <br /> Water,;u ply: Public 5 stem and name ......... Priv <br /> f� Cla <br /> Charcc-ftr or soil to a depth of 3 feet:Hard an At❑ Cloy [3 Peat FJ Sandy Loam Y Loam 6711 <br /> S0 N <br /> r ' p u dobe ❑ Fill Material . . ..�..If yes, type ......... ... .. .rf <br /> (P!at plan, showing size of let, location of system in relation to wells, buildings, etc. must be placed on reverse side3 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) J <br /> [ SEPTIC TANK[ J Size ..... .............:... _ Liqutd Depth <br /> PACKAGE TREATMENTCapacity Type Materiel..........:. .:..... N Compartments <br /> . .. <br /> K «V� F r a Distance to nearer Well <br /> Foundation <br /> top L <br /> ne <br /> �'� J1�^ LEACHING LINE� Nab of Lines Length or each line.. .....- Total a( Length <br /> "� Depth F !ter r tial vial <br /> D Box Type Filter aterial p <br /> �Az F � <br /> 4w. Distance to nearest: Well <br /> t'oundotion ,.. Property L ne <br /> x <br /> i Rxk Filled Yes ❑ No <br /> t " s <br /> C ,SEEPAGEhIT��r`� t+ Depth Diame er Numbe _ _ <br /> Water Table Depth Rock 5e <br /> t D stance to nearer+. WellFcundation <br /> REPh,;!✓ADDITION(Prev. Sanitation Permit*# ..•:-.:- Date r <br /> `/ ) P <br /> Septic laic (Specify Pequirements) _... - ... <br /> Dispo>al Field WSpeclfy Requirements) .....ttJ1.�-...:.. `.... .. ©F:. I <br /> r �Xl �1. 0 PTrc � .M .. .... _. . <br /> l D ................ <br /> raw existing and required addition on revers+- rid , <br /> nd thnt the work will bo done in accordat ce with San <br /> hereby certify that I have Jeuqui�t <br /> County Ord"ponces; State Laprepared this application aoaquin Lcual 1 Talth Distriet. {ome Owner or It <br /> ws, and Rules and Regulations of the San J <br /> ... <br /> sad agents signature certifies the following: <br /> "I cert' in the pe o' c �01'lhe work for which this permit is issued, 1 shat' net employ any p.rtontri such mas to bee subject Compensation laws of California." <br /> ...... OwnerSigned C lC�j� .. -� �L �f , _ .. <br /> c :. .. ..:. Title - <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> r <br /> ` D B:Y:LSC r c ` <br /> DATE <br /> A'PLICATION ACCEPTEDATE <br /> BUILDINGPERMIT ISSUED <br /> [�S[ <br /> A>DIT1 1, COMMENTS �Ir��,a r . <br /> -. ........ <br /> z. ... <br /> AN JOAOUIN LOCAL HEALTH DISTRICT <br />