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rwA %onl" u=: - <br /> AMICATtON FOR SANITATION PERM <br /> ......... ..................................... �i. (Complete In Trlpiicota) Permit Mo. .:�.7-Yy?- <br /> ................................................... res fir... TMs Permit Expil Year From Dab Issued —Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrtitt and install the work herein <br /> described.This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulattons: <br /> JOB A�aREss/L noN; _�-:�� ��..,, .......... ....... c>:Nsus T>�,cT <br /> Owner's Name J. : 4` "r.Tti�c?.. ...... .... ............Phone . ........ <br /> Address ............... .. . ........ --...............................City ._. .... .. • C <br /> Contractor's Name.(,tet :�.:,. . "artment <br /> ._____.-•......_..._----.......License# �,� .._ Phonefnstollotion will server ��Residence House Commercial❑Trailer Court E3 <br /> j Motel E3 Other............................................ <br /> Number of living ..� .... Number of bedrooms _'. ......Garbage Grinder,........... Lot Size ........................ <br /> Water Supply: Public System and name .................................--.::..... ..._�._....._....... .Private <br /> Character of soil to a depth:jaf 3 feet: Sand❑ Sift❑ Clay p Peat O Sandy Loam 0 Clay Loan 0' <br /> ;1i Hardpan❑ Adobe Q Fill Materia!............if ye; type................._....._. <br /> (Plot p1aA, showing size of lot, location of system i i relation to wells, buildings,ngs, etc. moat be placed on reverse lido} <br /> NEW INSTALLATION: INo septic tank ar seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ #fl SEPTIC TANK{ J Size......................... .............I........ Liquid Depth .......................... <br /> CaIpactty ..-_.--- -----• Type..................... Material------............ .... No. Compartments. ........-..... � <br /> Distance to nearest: 'Well" ......Foundation Prop.Line..... ....___� <br /> .............•--- - ....._... . D . <br /> LEACHING LINE No: of Linea _.............. 'each ling.. <br /> _ .................... Total length f <br /> _ <br /> 'D'ij Box __f. ... Type filter Material .... . Depth Filter Material .P.`........................_....� <br /> Distance to nearest Well ........................-foundation -±.....:........----.•. Property Line .................. d <br /> 56PAGE PIT I Depth ..._......---........ Diameter �-�""i Numbei:................r........... es No <br /> Cr <br /> Rock Failed Y <br /> Water Table Deter ----•---•......:........... �T....__.Rock Susi•• ...........----...... . <br /> Distance to nearest:Well ...•........... ....'` ?............Foundation .................... Prop. Line <br /> REPAIR/ADDITION(Prey. SaInlitation Fermi! ..........................:4._.............. Date _... .......�. . ..._ <br /> Septic Tank f5pedfy Requlrementsl ••-......... ..................._....._.___ ........ ......... .�.. I <br /> Disposal Field IS <br /> pedfy "Requirements} ...f % .1 - .,�,..,,. �. y ...•_. '. <br /> ..................................... �.................. . ...................................._....----..... ,........................... <br /> ,...................... J <br /> ............................................. .Draw existing and required addition on reverse side! . ... ... _...•_--.. j <br /> 1 hereby certify that I have.prepared this application and that the work will be done in aaerdance with San loaqulw <br /> County Ordinances, State Lows, and Rules and Rkgulations of the San Joaquin Local Health District.Rema ovines of lJcets• <br /> ;ed agents signature certiAes the following: '': - <br /> "i certify that in the performance of the work for"Icb this permit Is issued, I shall not employ any person In,such manner <br /> as to becomeej subject to Wo&maWs Compensation !awes of California." <br /> Signed [ ..... .... ........................................ _ Owner <br /> By-•............... ... .........1...... 1...... ...................-----•-• . Title .48 <br /> . . . - .......... ............................ <br /> {If other than owned <br /> li <br /> ----Mjt 01PARMIENJ USE ONLY <br /> APPLICATION <br /> ACCEPTED SY..... :.........:......... DATE : " ,17 ;7 <br /> BUILDING PERMIT ISSUED. . ................. .... _... ... DAT: D E <br /> AflpITIO L CQ ENTS .. — <br /> final inspection byt / %s+�+a►rc ................. ......_........................-- .-"-.... :J�_:: �......................._... <br /> ..............I.......................................Date . '7................ <br /> EH 13 2!t SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h .3H <br />