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FOR OFFICE USE: z <br /> APPLICATION FOR SANITATION PERMIT ` <br /> (Complete In Triplicate) Permit No...; <br /> .......... This Permit Expires t Year From Date issued Date Issued , � �/� <br /> s' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work !i►ete n� ` <br /> described.This application is mad <br /> �e <br /> in compliance with County Ordinance No. 549 and existing Rules and Regufationss <br /> " f 106 ADDRESS/L( N ....+ -/.��J�..� �, j�• ....._.CENSUS TRACT <br /> (� 9 ,C -fh.. ate. .�. ._ u. <br /> k Owner's Name ./-epi/-..... (N jZ <br /> / <br /> /...��..Q Phone <br /> I Address �.��•`�...._ ✓�Cfi.�'Or/� ._...•.. ...CityNl. L `r <br /> i . Contractor's Name. . . -�..�Q/1t..._... . _ .......License#`�. — 9��.. Ph a �„.� <br /> e <br /> i Installation will serve: Residence Apartment House C) CommercialQTrailer Court fl w' <br /> ease , <br /> Motel Q Other............... ...........•............... <br /> p z� <br /> Number of living units:..,_.-_-.. Number of bedrooms ..3. Garbage Grinder Lot Size <br /> Water Supply: Public System and name . g e <br /> .............................. ...:............,............................................. ..«sa.. Private <br /> Character of soil to a depth of 3 feet: Sand JK ❑ CloY ❑ Peat Sandy Loam ❑ CIaY Loam * r f} <br /> ❑ * .�k '��' <br /> Hardpan❑ Adobe Q Fill Material............If yes,type......>. ........ ... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 411dal <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 faQt) Vx <br /> ` PACKAGE TREATMENT ( j SEPTIC TANK[ j Size...................... liquid Depth ....... <br /> Capacity > <br /> p ty... .. Type ........... Material.. No Compartments <br /> t . <br /> Distance to nearest. Well ...................Foundation .....» Pro Line.........: � ' <br /> LEACHING LINE [ J No. of Lines ........ .. Length of each line.. ........ ... .. Total Length <br /> •D' Box ----.... ... Type Filter Material ...,................Depth Filter Material .... 771 <br /> .,.: ...,., * <br /> f Distance to nearest: Well .. ............ FoundationPro pert' Li <br /> r <br /> SEEPAGE PIT ( J Depth ...... ...... ...... Diameter ................ Numbe ..... Rock Filled Yes ❑ Na` *a <br /> Water Table Depth Rock Size <br /> Distance to nearest: Well ... ...Foundation Prop Line d ' <br /> $ : <br /> REPAIR/ADDITION(Prev.(ProvSanitation Permit# ff Dote ..... ... ... ) «A <br /> Septic Tank (Specify Requirements) . .. �C•._ �d... jS ,G�,Se7%,w!%� <br /> Disposal Field (Specify Requirements) ..... <br /> Y <br /> .. .... ............... . ..... .... .. _ . ........ ....... .._......,........_. ...,............. ... <br /> _ .- . .. _ _... . ......_.._....-..._ ........... ... .... ............... <br /> (Draw existing and required addition on reverse side) r, t <br /> I hereby certify that I have prepared this application and that the work will be done in accordance"with Sen""Jooqulna;"tY . <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health DistriN.Herne"owner er Ifeen-„ ' <br /> sed agents signature certifies the following: x ` <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such etemter <br /> as to become subjec to Wo man's Compensation laws of California." <br /> �s� t <br /> Signed _ _ Owner <br /> BY c/ ._ . _. Title .................... <br /> cif other than owner( <br /> F DEPARTMENT USE ONLY <br /> Z7APPLICATION ACCEPTED BY. , DATE r °T <br /> BUILDING PEPMIT ISSUED DATE. ............:..../--_ <br /> ADD;T IONAt COMMENT <br /> .. ........ ...... __ .... ....... ......_.......... <br /> .- 1 ✓r"y INw - <br /> VDate* <br /> t .... <br /> �! <br /> i7a e � r i <br /> u: - <br /> 3;* :'�A .U!t. LLCF, HEALTH D15T:?!CT <br />