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FOP,,OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..................... Perfnit Na. <br /> (Complete in Triplicate) <br /> ........................ This Permit Expires l Year From Date Issued Date issued .....-.... ........ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct end install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.- <br /> JOB <br /> egulations:JOB ADDRESS/LOCATION .._. ...O___.._�'W. ..;(il_ CQ <br /> I <br /> � �_ ..........................tet .. ................. .. ... ......................CENSUS TRACT ._...._._. .............. <br /> Owner's Name ---..._.._. '<... 11 ------ . .....----- ..., Phone .7.t--.�_ -� f......_... <br /> Address ._......... .......... �D_ -ee I._,eewG -**. ------------ ...... City . <br /> Contractor's,N ma e- ..-. �. ...?.... ........... ...............License # P �-..� 3.. Phone <br /> �13►... . <br /> Installation will serve-. - Residence tp'0�4 Apartment House❑ Commercial ❑Trailer CourtEl <br /> Motel ❑Other ........ - - • .. ----------------------- <br /> Number <br /> ------Nmber of living units:-../....... Number of bedrooms _-._7J__.._Garbage ;Grinder , Lot Siie _....._.4:2� <br /> r ............... <br /> Water Supply: Public System and name ` -................. . _..............---...----------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑�' Peat'❑ Sandy:,Loam a Clay Loam <br /> f <br /> Hardpan�j] 1 Adobe E] Fill Material ............ If yes, type .......... F._ ............. <br /> (Plot plan, showing size of lot, location dl.tsypterrt in relation to wells,buildings, etc. mu"st be placed on reverse side.) <br /> NEW INSTAI`LAt_1GN: {No septic tank or see,page�•pit,permitted-if public sewer is available within�00 feet,) ' <br /> PACKAGE TREATMENT rR <br /> - -- -. <br /> [ SEPTIC TANK{ Lt � Size.--..... _. ........................ Liquid Depth .--- �. ----- .--... <br /> CapacityAW4& l Type ::4ee,l--.---._ Material-user' .`--_-" No. Compartments ... --.-•-.•---- 6 <br /> e e r , <br /> Distance to nearest: 1Ne11 ?� <br /> -- "___ Foundation ...._�a__._....._.. Prop. Line ..s............. 0 <br /> LEACHING LINE to No. af-•L .. <br /> ines — . -_A_..Length,af. eoch�� line �.K_----._...-._. Total Length <br /> t .��.©.................� <br /> 'D' Box ..__! Type Filter Material .LSrIC ------Depth filter Material _..,��'.,��................._...........- , <br /> I <br /> Distance to nearest: Well ........................ Foundation _.... Property Line ....I............... <br /> .... <br /> J <br /> SEEPAGE PIT [ } Depth Diameter ....N•#.�•�.A+_-._ Number . , ; -»= Rock Filled Yes ❑ No <br /> ``+..Y��V-- { f <br /> Water €Table Depth . ...�__.__.. ,. <br /> ------------------------------------------------Rock Size ..........----- - <br /> Distance to nearest: Well ...............•-.---•.---------------Foundation .. .. ..... ._.�... Prop. Line .._..... ............ <br /> REPAIR/ADDITION(Prev, Sanitation Permit# .........................................I.. Date—.---.-•---------------- <br /> SepticTank {Specify Requirements) ............................. ..----_---..__........---••-•--------------................................------ .............. <br /> Disposal Field (Specify Requirements) ..................... _y�-- -.-- ...._._._...------------.-----._.._.... <br /> -------------- ----- <br /> ............- ---------- -- -- .............. .... . ...- ------------------------ -- ------ ------------- --- -�- _.:...... - ..........------------------------------------- <br /> _..... I <br /> {Drdw 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 /> "I certify that in the performance of the work for which this permit is issued, I shad) not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---- - -------- ----- --------- ----- Owner <br /> By .... /' '-� .-.. ,... .._ - ........................ Title . ... .!........ ,.... .. �, <br /> {If other n owner) � "! �� <br /> jq� .,.EPAR�T�MFNT U5E ONLY <br /> APPLICATION ACCEPTED BY .- -------- -------------" .-----......-- ...._. DATE ._. :J. . _.. .. _: ..BUILDING PERMIT ISSUED ............._....... - ......--•---.....----•-. . •. DATE _ _.. ._ ...... ..---..._._..------.- - - -------- <br /> ADDITIONAL COMMENTS ................. . ............ ............ , <br /> ........... --- ------------------------ -- ...._...._._ .........................---------...............•........_...------ <br /> -- -------- .....----- ­_­­..._1.11­.... ...... ....--.--..... . - - ---- ------- <br /> ------•----------------•------..._.. .. .........--- . ------ -----.. .....------. -------- ---... �. .� <br /> Fina( Inspection by: --------------------- <br /> --•------ - .................Date .. .... .-. ` <br /> SAN JO QUIN LOCAL HEALTH DISTRICT <br /> i <br />