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r%.,K "= APPLICATION FOR SANITATION PERMIT <br /> ...... .................................. 1Compleft In Triplicate) Permit No. <br /> .7..6..:a <br /> .................. ............................. This Permit Expires I] Year From Daft issued <br /> Date issued ., :��:''6 _ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to contract and install the work heroin <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/IOCATION . .. `�.- .... ���r' ., rC L,"...l.�'G�. .............CENSUS TRACT .......................... <br /> Owner's Name ............ G . "f`-,C., ..... .'....................................................Phone <br /> Address ....... .�4-796--------------•....--•--......................City ............................................................................ <br /> Contractor's Name /1 ...................................License# ........................ Phone .............................. <br /> installation will serve, Residence Apartment House Commercial❑Trailer Court <br /> Motel []Other............................................ <br /> Number of living units:.. ...... Number of be oo s!�-?....Garbage Grinder ..C!! .. Lot Siete ... .. .. <br /> Water Supply: Public System and name ------------ ..46 l4 ................................................................Prhrots 'gyp" <br /> Character of soil to a depth of 3 feett Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam <br /> Hardpan❑ Adobe Q fill Mcterlal ............If yes,type............... ............ <br /> !Piot 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,} <br /> PACKAGE TREATMENT ( ] SEPTIC TANK( ] Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .................... Material..............--...... No. Compartments ................ <br /> Distance to nearest: Well ..........Foundation .. Prop. Line ......................� <br /> �EACHING LINE } } No. of Lines ........................ Length of each line............................ Total Length .....................:...... <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ . . <br /> .SEEPAGE PIT [ ; Depth .................... Diameter ............... Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth ................................................Rock Site ................................ <br /> 40 <br /> Distance to nearest: Well ........................................Foundation ............ ....... Prop. Line ................. <br /> ....� ; <br /> Q EPAIR/ADDITION JProv. Sanitation Permit# ............................................ Date ................................ .} A <br /> Septic Tank (Specify Requirements) .............................. ................................................... ....._. ..........------- <br /> .....� <br /> Disposal Field [S cify Requirement `_'". .. - ....��'.��. r .._ jl �i?�'.... <br /> .. <br /> -X.....a ... . <br /> ...... ... ... ..............................................................•- ...-- -- <br /> .•...................................................................................................---...................................................----.-•---.......................•.--.. <br /> !Draw 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 wlth San Joaquin i <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome 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 shall not employ any person In such manner <br /> as to becomes ject to W *man* <br /> ompensation laws of California." <br /> S:gned .... _.. .. Owner <br /> B --- Title ........................................................................ <br /> If other thou owns <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... ..... . ...... DATE ........ <br /> BUILDING PERMIT ISSUED .. ................... .......:....-.......'................ ............................ DATE-,. . <br /> ADDITIONAL COMMENTS ... 9............GKc?'�.�,�r!�- --.v�-r. .p?� .eft ...- -.G!.F .... .................................`.............•..... <br /> .. . .. ..............-•---•---•------------------....--------.................................... ...............--... ...-..... .I................. <br /> ................................. --------•---..................- .................................................... ..... -...._.................- <br /> .A.. <br /> - ........ ...............................• .......__.......... .... ... _...-... Date ---............ <br /> final Inspection by: ---.. .--.... .- � . .. <br /> EH 13 2h 1-613 Rev. cN SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />