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4 FOR'OFFICE USE: <br />.�- - �, • APPLICATION FOR SANITATION PERMIT <br /> r <br /> (Complete in Triplicate) Permit No. ..7._.'' �>!. <br /> ................ ...:......................... Date lssuedj-4;-�N. <br /> 4 This Permit Expires 1 Year From Date Issued <br />-------------- <br /> `fApplication is hereby made to the Son Joaquin Local Health District Poria permit to construct and install the work herein <br /> cescribetE h7h�s:Uappiicotion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ' <br /> TRACT TIONJOB*ADDRESS/LOCA .............................. <br /> �y `� <br /> 'Name47 �5 .. . . ..........--•• :. .................. Phan <br /> Owner g_ . e <br /> r Address .:. :RIEt.......B�^��-j- - �„� ...._.---------- City =_.----------........__.__.......--•----.........._..... <br />,t Contra t r s Name !'.:. .:.._.1: - = ----------License ` :'` ..... Phone <br /> ...... ..........:. <br /> i Installation will slenr y Residence &Apartment House❑ Commercial (]Trailer Court 0 <br /> Motel ❑Other ..................................... <br /> ------- .. <br /> ' 4•l <br /> Number of Rliving units-.4....... Number of bedrooms __:4' ....:Garbage Grinder ------------ Lot.Size <br /> Supply:pPublic System and name ---------- <br /> Water ...................... Private®. <br /> F * - „�'... . .y 3 <br /> i< Character of oil to a depth_of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ "`-13 <br /> rte" Hardpan F1, Adobe ❑ Fill Material ............ If yes, type ............................ I <br /> I <br /> (Plot plan,plan, showing,'size of Jot, location of. system in relation to wells, buildings, etc. must-be$placed, on reverse side. <br /> NEW INSTALLATION::'. (No septi tank or seepage pit permitted if public sewer is available within'2OO feet,} <br /> , Depth ............ ---......_- <br /> PACKAGE'TREATME. T []• SEPTIC TANK f Size.__•••..................................... Liquid <br /> r <br /> r ` Ca}�acity ..................... Type .................... Material_-.._..------._::--_ No. Compartments ._...................... <br /> C' <br /> Distance.sto nearest;Well ..........................:.........Foundation ..._.__n......._ Prop Line y ... <br /> ei r r-. <br /> ,F <br /> LEACHING-LINE- . . ........... <br /> f[ ] ;No: of Lines ..-'-----------------•.- Length of each line----------- <br /> :.._... Total Length ....................... <br /> 'D'i-Box ....----•--Type Filter Material ....................Depth Filter Material .......................... <br /> Distance Ito nearest Well . ................. Foundation .........................4Property Line ... NK <br /> '. <br /> SEEPAGEPIT [ j . , Depth k Diameter ................ Number ..____.__..._.. ............. RacV Filled Yes ❑ No Q <br /> PsT�t Water,Table D"';p th ...Rock Size ---_---_------- . <br /> y / ; <br /> Distbnce;ta'neareit Well .........::.........................Foundation .... - Prop. ........... <br /> w .. <br /> REPAIR/ADDIT_ION(Prev. Sanitation Per it# _..___._'....:...........:................ Date ----------•-•- ...... ) r <br /> Septic TankRequirements <br /> 4(Specify } .. __................................. - ._t-:.__. . .._. _ r R <br /> { <br /> Pis `,Field (Specify Requirements}w :___ -i+•._ : _..__..-•-- <br /> a <br /> 4 <br /> - �• '-- 7 S "'S-+-•x.11__`_ ._ ._ ..._.. __.._ .................................. <br /> '.................... ----------------- <br /> ...:...... -------------------------- ­1------ _................................................................................. <br /> (Draw existing and required addition on reverse side)*',;.' `•' y <br /> 54 <br /> 4.hereby certify ihat',I have preparecl4hi"s application and that the work will!bV� one in accordance with Son`+°Joaquin . <br /> County"Ordinances, State. Laws; anis�Rules and Regulations of the San Joaquin Local Health District. Home owner'or licen- <br /> sed agents signature certifies the&Rowing: 4L <br /> 1 certify shat in the-performance of''�the work for which this.permit.€s issued,'I shall not employ any person in-such manna# <br /> ' as'to become sublet to Wdrkman. Compensation laws of Califoirnia. , x ,` <br /> b Signed .. h ---- --- Owner <br /> 1 w , t «. <br /> t. <br /> By - 4 .. .. . . �. ?' _., .. . ` _F.. Til . • .............................. .......- <br /> (If other than.owner) t" <br /> FOR ID&ARTMENT USE ONLY <br /> BUILDING, PERMIT ACCEPTED,BY <br /> r f <br /> APPLICATI PERMIT ISSUED: �.:_�+ ► Ye r ......� -D ........ . --.... - <br /> ATE '` <br /> ADDITIONAL`-COMMENT5 >°' " "" -- f` E .....`.........:..:..`l/. - <br /> a t <br /> f fix'- w - - _ � '✓ <br /> ---- ................ . :.. ....... ..... .. <br /> ..................... ........... ................................ .................... .; ........ ........... ........ . <br /> r Final inspection by: .............. = ::... <br /> .x - SANJOAQUIN LOCAL HEALTH' DISTRICT: <br /> AT :,y <br />