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FOR 0FFICE U APPLICATION FOR SANITATION PERMIT / <br /> . ... Permit Nes. .����.7Jc' <br />......................................I.......... .. (Completo In Triplicate) <br /> ..................................I............... _ .. Dab Issued�.- 7 <br /> .. ......... I........ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Rogutationsi <br /> JOB ADDRESSAOCATIO f-.<. . �_. .... .. ....................................CENSUS TRACT .......................... <br /> Owner's Nome ....... ................................. ... ........................ ......Phone ................................. .. <br /> Address0144­1e.k.... •---••--•--•--•...............................City ..................................................�.. <br /> Contractor's Name ..Cr'� . .... ...............................................license Phone : ... <br /> Installation will servox esldence Ul-ftertment House C] Commercial(:rTrailor Court 0 <br /> _ <br /> Motel-13 Ether----•-•....................•................ <br /> Number of living units:............ Number of bedrooms .9.....Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply= Public System aid name ._._ ....._... . ........................._................-----.......................-----...Private <br /> Character of soil to a detsth of 3 feefi Sand❑ Silt(3 Clay ❑ Peat❑ Sandy Loam 0 day Learn❑ <br /> • Hardparti❑ Adobe t] 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 /> NEIN INSTALLATION= "(No_septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f]- SEPTIC TANK( Size....... ..... Liquid Depth <br /> - <br /> pe ..G '`. Material...................... No. Compartment: <br /> Capacity M � � Ty .'" •..--....,� <br /> of ..... Pro Line t <br /> Distance to nearest= Well, �,4�............................ .l4........- p• ..........._..--.... <br /> LEACHING LINE [ ],'--No. of lines .. Length of each line............................ Total Length ............................. <br /> Box J........ Type Filter Material ....Depth Filter Material e.................................... <br />` foundation Property Distance to nearest= Well ... Pr Line ..................,.... <br />-. SEEPAGE PIT [ I Depth .................... Diameter ................ Number ............................ Rock Filled Yeti :No <br /> Water Table Depth ................................................Rock Size ...... ......................... • ' <br />. Distance to nearest: Well ........................................Foundation .................... Prop. Line .........-........... <br /> � <br /> REPAIR/ADDITION(Prev. Sanitation Permit ........ ... ' ... Date ............................ <br /> Septic Tank (Specify Requirements) ............................................................ .... ... ............. ............_-.....,.. ._.............. . <br /> Disposal Field (Specify Requirements) <br /> .• ..............•-.................................._...................................._......... .` <br /> rn ............................ <br /> ............. ........._......................................................................1............I........ <br /> (Draw existing and required addition on reverse sidel <br /> I hereby certify that 1 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 no <br /> Distrid.Hoene owner of liven. <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 becotpe subject to Workman's Compensation laws of California." <br /> Signed ._L�c. ..s...'.. tet! ................................................ Owner <br /> By ............................ ••--... .................-•-•-----•--•.......•-•--•........ Title .......................................................... ............ <br /> (tf other than owner) <br /> K?R DEPARTMENT USE ONLY l <br /> APPLICATION ACCEPTED BY ... ... .............. DATE .....16.=... :.`: .....:: <br /> BUILDING PERMIT ISSUED ........DATE......... ••••-• <br /> ADDITIONAL COMMENTS •................••------..................---._I............................ <br /> ........................... ----••-..«....._...................... ---.................... ; <br /> .............................. ............ <br /> -... . <br /> Final inspection by: ..............................Dale -..� ._. .. ........... <br /> 13 2� J--b �►• 514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7t, 31l <br />