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OFFICE USE, APPLICATION FOR SANITATION PERMIT <br /> -- Permit No. .. <br />. ........ .. [Complete in Tripticatel # <br /> .......................................... Dab issued .�.: ... <br /> . . . .. This Permit Expires 1 Year From Date Issued <br /> l the <br /> Application is hereby made to the Son Joaquin local Health District for Hance Na 549 and exlstlnQ Rulesit to constrtid and talnd Regu#o�tlonsrein <br /> described. This application is made In compliance with County, <br /> OCATI N <br /> ..............CENSS,T CT .............. .......... <br /> JOB ADDRESS/t <br /> Owner's Name •C_� �s�... ° j. r7u ...................... ................ ..... <br /> Address ..... 2� �......�d.!�Fi +!p�1 •.Ji .......... <br /> ................ •.City ... rt`! .. ? .. ............................... <br /> ....License # ....... . ............. Phone <br /> Contractor's Name .............................. <br /> Installation will serves Residence[Apartment House[) Commercial OTraller Court 0 <br /> Motel p Other............................................ 02 .. .� <br /> Number of bedrooms � Garbage Grinder -__ ' <br /> Number of living units:...�...._ --....... _ ............ Lot Sise ......._... <br /> Water Supplys Public System and name ............................ ...................... ........................... <br /> _......................Private� Q <br /> Character of soil too depth of 3 feet: Sand O Silt❑ ClaY..Q--x Peat❑ Sandy roam O daY Loam <br /> Hardpan Adobe Or Fill Material ............If s ye ,type............... ............ <br /> (Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or see pit permitted if public sewer is available within200 feet,} 1r <br /> y r <br /> ' s ... . ...lD ......... Liquid Depth . .............. <br /> 0 <br /> SEPTIC T � ... -- . <br /> PACKAGE TREATMENT [ 3 � a __•-.+..........: <br /> .. �. I'Material. ,NdR 'No. Compartments --- - ......�..--.'� <br /> Capad . ............ Type .ft. <br /> r t: <br /> Well, .,��__..?� .......................Foundation <br /> ../..�.':�:......... Prop. Line -..... <br /> Distance to nee es <br /> .... Length of each line... .�•--••••••-• Total Longum .,.��Q ...•--• <br /> LEACHING LINE No. of Lines ... ....... t , f� <br /> 'D' Box h,..,S-- Type Filter Material ��`a�.'.Depth Filter Material ........1_/............................ <br /> to nearest: Well /0,0. . .... Foundation .....I.:Q....f.......... Property Line ...�42I....... <br /> Distance ..../40,0 <br /> Filled Yes'C3No C <br /> SEEPAGE PIT ( D Depth . Diameter Number ................. ........ <br /> Water Table.Depth --•-•...........................................Rock Sicca .................... ................ <br /> ' Well .Fou ion .................... Prop. Line <br /> Distance to nearest: ....................................... Foundation <br /> .................... <br /> ' REPAIR/ADDITION(Prov. Sanitation Permit# ......................... . Date .............. ............... -I <br /> Septic Tank (Specify Requiremental ......................................... .................--- •---..................................�............._..........:..... <br /> Disposal Field (Specify Requirements)......... .................................................................................................................... <br /> k ............................................................... <br /> ..........................................: <br /> ........................._...........-•-•-._.........._.... ----....................... <br /> (Draw existing and required addition on reverse sidel <br /> ! hereby certify that 1 have prepared this appi[cation and that the work will be done in accordance with Sen Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Norrie owner or Iket� <br /> sed agents signature certifies the followings <br /> "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 /> as to becom lect to Wor n' amps ation laws of California.'" <br /> Signed . ........ ............. <br /> ......_..... Owner <br /> 9 <br /> :... title .......................................... ......... <br /> ...................... <br /> ............ <br /> ...................... <br /> ............... ................... <br /> [if other than owner) <br /> ' FOR DEPARTMENT USE ONLY <br /> _ DATE ....-�`.�,�fi.-.�-�.-....._.•_-: <br /> APPLICATION ACCEPTED BY �A-R-V` y1 -50 _ <br /> .... <br /> QV -...... 11. ............................... :.........DATE -..--......- <br /> BUILDING PERMIT ISSUED ............. . ...... <br /> ADDITIONAL COMMENTS ........:..................................................... <br /> ............... <br /> ...................................:....._-••..-.,-.-......• •.......•.-----...,.. .. •.....•j.... ......- ............--•-•.......--..................--.....................................'....-- <br /> ....... <br /> ........... ............ . - ...r.r.. ........... .......-................-... ................ <br /> . ... <br /> .....................•............... Date <br /> .................................... ate • .. . <br /> Final Inspection by.Eli 13 13 24 1-bll fwv. 5)4 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />