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Y 1 OFFICE L1SE: h: APPLICATION FOR SANITATION � <br /> Yf N PtRMtT <br /> .................................................. :I�. Permit No. .. <br /> (Complete in Triplicate) ...... .... <br /> ............:..................................... This Permit Expires 1 Year f=rom Date Issued 'gate Issued Ot z-L <br /> i Application is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herein <br /> described. This applicatiari`'is made In compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> I JOS ADDRESS/LOCATION �.-:.; .!.V--- ..-e- .................................CENSUS TRAC'9 ... .... ... <br /> ' Owner's Name ...�� .............................................. ...................................Phone .�. •.�. ��..... <br /> Address ...------ / it .4-..Ael..................I..................City -----..................... ......................................... ... <br /> Contractor's Name -L_ - .�c-- •. ----------•---------•---.........••...................License ` 7. Phone <br /> Installation will serval esidence❑Apartment Houset] Commercial❑Trailer Court ❑ <br /> Motel[]Other------•------------------------------------- } <br /> Number of living units:..._ ------- Number of bedrooms . .....Garbage Grinder ------------ Lot Size ......................................r.. . <br /> Water Supply: Public Systtim and name .................................__...................._..................................................Private®— <br /> Character of soil to a deptH of 3 feet: Sand E] Silt❑ Clay El Peat❑ Sandy Loam 0 day Loam ❑ <br /> ` <br /> ' Hardpan® Adobe❑ Fill Material` ........... if ye:,type <br /> k <br /> [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,l <br /> PACKAGE TREATMENT ( I SEPTIC TANK J J Size................................................ Liquid'Depth ..........................00 <br /> Cl-pacity llzm AeType ���aterlal______________________ No. Compartments __'. :.........-i✓ <br /> Distance to nearest: Well __beef .........................Foundation ... ...... Prop. Line ............... .... <br /> { LEACHING LINE [ No. of Lines _-�- ................. Length of each line...`f.� .....__......... Total Length , ............. N <br /> '®f' Box __l....... Type Filter Material ..G .....Depth Filter Material .�.../.'............................... . <br /> f ,. <br /> Distance to nearest: Well ..........•............. 'Foundation ................-------- Property Una .......................- <br /> t. SEEPAGE PIT ( � Depth .................... Diameter ........._._ ... Number ............................ Rock Filled Yes ❑ N, Q9 <br /> Rock Size fr <br /> � Water Table Depth ................................................ , ........._._........._ ....... � <br /> Distance to nearest: Well ................._.,_...................Foundation .................... Prop. line .........r........... <br /> REPAIR/ADDITION 1Prev. Sanitation Permit# ..........................------------------ Date ..................................� <br /> Septic Tank (Specify Reliuirements) .._...................................... ..........._.. ..................................,........;. ........---........ ` ... <br /> ► Disposal Field (Specify Requirements) •..................................... ......................................................................................... •..... <br /> ............. ............................. ............•.............................................................................................................. ,.......................... <br /> ...... <br /> ......:....... ....... �I........-- .._......-•---•--•--....._............_.........._........_......_•--•................................................................. ..... <br /> � (Draw existing and required addition on reverse sldel <br /> h certify that I hato prepared this application and that the work will be done in accordance with San Joaquin <br /> I hereby a fy a p p Pp <br /> County Ordinances, Statel[Laws, and Rules and Regulations of the Stan Joaquin Local Health District. Horne owner or 11con- <br /> sed agents signature certifies the following: <br /> "I.certify that in the perf4mance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California" I <br /> Signed ...[.� �� � .. .. <br /> �...... . . .............I......---.......---................. Owner <br /> B ........................................................•--------.. Title .............................................................. <br /> lif other than owner) <br /> FOR D ' ARTMgNT USE ONLY <br /> APPLICATION.ACCEPTEDI[BY .4 <br /> . .............-......:.................., DATE ... <br /> 'z --- ........ .. <br /> BUILDING PERMIT ISSUE, :........... ........DATE -:...............- ................... <br /> ........ ................................ <br /> ADDITIONAL COMMENTS �.................:........................... <br /> M..... . ........... . . ................. .....------............... <br /> iv, <br /> ....... . ... <br /> .. ..... ........... --- --- .............. ........ <br /> .. -. ,�..... <br /> Final inspection by .. . <br /> Date ....� :" .... <br /> Edi 13 24 1--til] : SM SAN JOAQUIN LOCAL HEALTH DISTRICT +8/7h 3M <br />