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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ...................... Pe <br /> (Complete in Triplicate) Permit No. .f�!... <br /> ...................................................... <br /> ................................:........................... This Permit Ex;iirts I Year From Dais issued Date I!sued.X,?/!T._P.0 <br /> Application is hereby made to the Sun Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compi"ince with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> ..... ............... CENSUS TRACT _.__..._._.._». ._. <br /> Owner's Name ..... ........ ............. ............. Phone <br /> Address <br /> City ------------- <br /> Contractor's Name .........01IX' ,a ......'W'. r5 ..41- ...License# 19JV S_.Y. Phone <br /> Installation will serve: Resido-nc' Apartment House 0 Commc,-Jol C]Traiier Court 0 <br /> Motel E]ahe................................... <br /> Number of living units-..-./..... NumSer of bedrooms?.--.....Garbage Grinder ............ Lot Siz,: ..................... <br /> Water Supply. Public System and name .. ................................................ .......... ..........................Private, <br /> Charcicterof soil too depth -f 3 feet: Sand S;Ito Cl <br /> 0 PeatC] Sar dyLoarno Clay Loam[] <br /> Hardpor,E] Adobe ll 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 I&.) <br /> NEW INSTALiAT"N: (No septic tank or seepage pit permitted if public se"r is available within leo feet,) <br /> PACKAGE TREATMENT SEPTIC TANK f Size-------------------------------- Liquid Depth --------- <br /> Capacity ...... ............. Type .................... Material.---------------_-- <br /> No. Compartmerft <br /> Distance to nearest: Well ....................................Foundation .... - ­ ----------­131rW. <br /> LEACHING LINE No. of Lines . ... ........ ...... .. Length of each line......._. ...... Tjftl length <br /> 'D' Box ...... Type .7;Iter Material ...................Depth Filter Material ........ <br /> Distance 4o nearest: Well ........................ Foundation ........................ Property Line <br /> SEEPAGE PIT Depth .................... Diameter ................ Yes 0 No <br /> Number . ......................... Rock Filled <br /> Water Table Depth ... ............................................R,>&Size................................ <br /> Distance to nearest: Well ...................................-...Foundation .................... Pyap. Line <br /> ROAM/ADOITION(Prev. Sanitation Permit#............................................ Date ..............................».I <br /> Septic Tank (Specify Requirements) ........... ................................................................ <br /> Disposal Field (Specify Requirements) ............................ . ...... .................. .......E........................ <br /> ------- . ..... AL <br /> ...................................... ....... <br /> (Draw existing and required addition on revefse s <br /> I hereby certify that I have prepared this application and that the wool will b* dmw In occordeace VA& Sm jen4a <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joovuln Local floeCh District.Heiiiiie owner w Maw <br /> socl agents signature certifies the following: <br /> "I versify that in the performance of the work for v/A"Akpwinit is issued, I Owl*0 =Ils a-Y any INNOM is 906"Mmaw <br /> as to bocome sailqed to Wor"swio,"Comp""Mon 4ows of c01:fen"." <br /> Signed ........................... 7 ......�. Owner <br /> By_....... . . ...................... <br /> Title .................. ................ ....... <br /> (If other than owner) <br /> FOR Otli>' MifdT USF ONLY <br /> APPLICATION ACCEPTED BYL>5ftA-__ 7, ....................................................... DATE....1-.- <br /> BUILDING PERA41T ISSUED................................ . ..............................................................DATE......... <br /> ADDITIONALCOMMENTS........................ ............. . ................................................................................ <br /> .... ............................. <br /> ...7.....-4..... <br /> . <br /> ...... <br /> ...I.... ....................... .....I '' .... .. .......... ....... .......... <br /> ......... . . .........................................................Final Inspection by:.... ... .... ............... .. ... .. ............­.......Dote.... ... . <br /> .. . ..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRI(T <br /> E.H.9 1.*68 Rev.5M <br />