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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> i <br /> (Complete in Tri Iicatol Permit No. ...:..:' <br /> P P <br /> .....- ..._............... .............. 7- 2 -7 i <br /> This Permit Expires 1 Year From bale Issued Date Issued . .....'.- <br /> � <br /> deribed.This <br /> p�icoticn is happl ca on ismadein compliamade nthe ce cewith County O d nnce Districtuin Local Health for <br /> No. 49and existing 549 construct and and Instal[ the work herein� g Rules and Regulations: <br /> .SOB ADORESS/L TIO[i � { z- Z 1 ��— `� CENSUS TRACT <br /> Owner's Name � Phone .... <br /> Address <br /> ' � �.--�--./.... . _ �...I.............='pity ... <br /> ... <br /> Contractor's Name..._D. �` -r..�... License#s�t .1�..?.:... Phone ....... ..................... <br /> Installation will serve: Residence[]Apartment House ICI Commercial❑Trailer Court ❑ <br /> r Motel❑Other........................................ <br /> I � <br /> Number of living units:..,........ Number of bedrooms ­1 Grinder ............ Lot Size ......---- <br /> Water Supply: Public System and name---... ..... ........................__...-__.1r­­­­ �— <br /> Character of soil tb a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam[ lay Loam❑ <br /> iHardpan❑ Adobe❑ Fill Material ............If yes,type................. <br /> I (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 [] SEPTIC TANK{] Size................................................ Liquid Depth ..........................lS <br /> Capacity..........------ Type .................. Material...---. --.......... No. Compartments ...................... <br /> Distance to nearest: Well ------..............................Foundption......................Prop.tine....- ts <br /> LEACHING LINE ( ] No. of Lines ........................ Length of each lino---- _...... Total Length ........................--..� <br /> ' 'D' Box . ......... Type Filter Material ....................Depth Filter Material ...................................-.... <br /> .... <br /> Distance to nearest: Well ........................ Foundation -_--- ...... Property Line ........................ <br /> SEEPAGE PIT [ ] Depth ................... Diameter ..-............- Number . .... Rock Filled Yes ❑ No❑� <br /> 9 . Water Table Depth - --- -. ......................Rock Size......... ................._ `� <br /> Distance to nearest:Wel[ ........_...................__......Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITIONIPrev.Sanitation Permit#............................................ Date ._...----_...._................I <br /> Septic Tank (Specify Requirements) ............._...p...... ..._................... --_-----_-------------r--i� - ......-..... .. .� <br /> Disposal Field (Specif. Requirements] <br /> � -r:.P l l�.L.a, _. .7:_-;v..../.✓. sF'- .�-,.rte.3 ... `t - ....... ��..:......, 4-'. ,' <br /> - - ............... --...............................--- <br /> IDrow existing and required addition on reverse side) <br /> I 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 District.Home owner or licen- <br /> sed agents signature certifies the following: <br /> S "I certify that in the performance of the work for which this permit is issued,I shall not employ any person In such manner <br /> r ! as to become subject to Wor n's Compensation laws of California." <br /> Signed..........-- �............. ---- --Owner <br /> By---------------------------------- --- 4 ,.. Title..r1.[cJ1, �::�..e.............., .... <br /> �+ �( <br /> (If other than owner) <br /> i <br /> FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY - ....-----------.......................... DATE - V F - <br /> BUILDING PERMIT 155VED .. ............. ....... ... .. . .... ..DATE . <br /> ADDITIONAL COMMENTS .... . ... ............ ................_. <br /> I - - <br /> ..... ......... ........... <br /> -------------------------------------- ......... .......................................................-.................. -.. <br /> .................................. <br /> i.w ...- -_ ...r° ..........�......:!.;...._:;........... <br /> ...........- : W .- ..... .......... ............................ ....... <br /> FinaInspection b .............Date <br /> W . <br /> 13 2!t 1-611 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> r <br /> PL <br /> t �I <br /> i <br /> ! r <br /> 4 <br /> i <br /> d ' <br /> � 1 v <br />