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EOR OFFICE USE, <br /> ... .. ; . . . .. , APPLICATION FOR SANITATION PERMIT 7s 7ez <br /> (Complete In Triplicate) Permit No. <br /> .. . : <br /> .............. .................. ry , <br /> .. .... ... .. . This Permit]Expires 1 Year From OatoIssueel <br /> Dat® Issued .7:. :. :..7S <br /> . ................. <br /> Application,Is hereby mads to the San Joaquin local Health District for a permit to construct and Install the work herein <br /> described. This application is made 1n-cor I rhe#with C`o n edinance No. 549 and existing Mules and Regu1cfflon=: <br /> }�_ �o.� .. ..sifde.,of .Leach_So. of-More <br /> !; JOB AI31?Rf:SS/LOCATION .. ...................... .. ......... t ._........ � RACT ... ....,....... ....,. <br /> ! Owner's Name Phil l Br e t t ..... . ........................ .. .. .....Phone ........................... <br /> .,:......, <br /> Address .............................. .353.. iver. .�r............................................... <br /> .............,..............._.. S ac....L'o'ri.............-........: .................... <br /> .city .e.. <br /> Contractor's'Nome ...... .R0,t&.....$p,o . ...............:....................License# ...... Phone? .:�. �. ...,.....: <br /> Installation will serve: Residence®Apar�tm'ent Housed Commercial E]Trailer Court E3 <br /> Motel 0 Other...............d.......................... <br /> Number of living units.--I......... Number of bed oro s3_:.:....._Gar64e Grinder yes:.... Lot Size ..aax:e.a a................._....... <br /> Water Supply, Public System and name" ...............................;. . <br /> ............. .. .. . .. <br /> .. ..........................................hwateb, <br /> Character of Boil to a depth of 3 fob Sand p Slltd Clay p 'Peat 0 Sandy Lesion 0 Clay Coam J3 <br /> ' Hardpan 0 Adobet3 fill Material.. :` ....i#lyes,type. <br /> k ...... .... ............ <br /> )Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc. must be placed on reverse ski.! <br /> NEW INSTALLATIONt (No septic tank or.seepage pit permitted if4 yblX�sewer s jvailable within 304 feet) 4 ., <br /> PACKAGE TREATMENT [ SEPTIC TAW f) Size............................................ .... Liquid Depth ................... .� <br /> Capacity .i.24©••-•-.. Type .pxte.cas.t,. Material-c x:e.te No. Compartments 2:. ..:.. .......�' <br /> Distance.to nearest: Well 0...._-?lus � 5 <br /> 3 ' ... ,..,.... Qurld$tigrto{.°:':...:... ?lp. une� .b.i ?lus..:.r.. <br /> LEACHING LINE No. of Lines ................... Length of each line.... ......... ��..... Total Length ........M <br /> 'D' Box $s. .:. Type Filter Material ....r.op-k.....Depth Filter Material .... ... <br /> r_ �.Distance,-to-nearest:-Weil Eoiindai.Ion .}........ .. Property Ling�...��..�................. <br /> SEEPAGE PIT f.) Depth ....25.!......... Diameter .33.'.'......:. -Number .... . ..3................. Rod Filled' .Yes 0 No <br /> • .mow 4 <br /> . Water Table Depth .... ..... ... ...........stock Size .....14-by3 ?......... <br /> f Distance to nearest: <br /> k Well ......:.....1�0.'......... lflt ) , <br /> . . ....... roA. ne 5. .' <br /> ...... <br /> REPAIR/ADDITION lPrev. Sanitation Permit# ............................................. Date .................................... <br /> Septic Tank )Specify Requirements)....:...... .................. . • ........................:..:...---- •-.... . .... .............................. <br /> . <br /> Disposal Field (Specify Requirements) ......................:.:.......................I..................... ...................:................... ........................ <br /> ... . ............. ...... .......--•--•------------..... •-----.... ......---........................... ............... ._.....,........................ <br /> (Draw existing and required addition on reverse side} <br /> I :hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joagvia <br /> k <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquln Local Healsk District. Home owner or Risen- <br /> sod agents signature certifies the following: <br /> W certify that In the performance of the work for which this permit is Iss�#,_!_shc�ilR sot-mnptay-cis '�Sireon Ing such r;tannai <br /> as .to become sub ject_to;Workman's-Compensationyiaws of C4ii#ornir�." <br /> T Signed = Owner . <br /> Contractor ' • <br /> BY -------------•----...... ! Jitle ....... <br /> ---------------•--...---.-•-• ......................... <br /> of than owners <br /> FOR DEPARTMENT USE ONLY <br /> : `. .. ... .. .... . .......................................DATE ........................CCEPTED BY <br /> BUILDINGPERMIT ISSUED ........ ................................................................................................DATE --- ............._...................... <br /> ._. <br /> ADDITIONALCOMMENTS ................... .............................................................._.............,......-. .._........._............I............... <br /> ..... <br /> ---.-•........: .........•--.--•---•--......-.:........._._............-.....__._._._..._..-----------............ <br /> .......... .......................... ...... ......... 9 <br /> Final Inspection by ................I........................._.._..........Date . .....� ....Ell ................._ <br /> 3 2!t 1-6f3 dev. S.AN JOAGIUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />