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FOR OFFICE USE: , <br /> ago <br /> APPLICATION FOR SANITATION PERMIT <br /> ... .. __. (Complete in Triplicate) ...._.. .. .. <br /> P <br /> emit Ne. .� <br /> • <br /> ..r <br /> i This Pertttlt Expires 1 Year From Da»Issued Date Issued/.�. :7�.. <br /> Application is hereby made to the Saw.1wcf in LocalHealth-biatfic"t"'far a permit"toconsMucf and--Install the work hereln <br /> described. This application is made in'compliance with County-Ordinance No, 549 and existing Rules and Regulations: <br /> 108 ,ADDRESS/LOCATI N .._ -`L � <br /> .. ................. .......................................�....... ...CENSUS TRACT ..:...,................... <br /> Owner's Name r .......... p ........... Z.. .' '� ' .Phone . ..�.. <br /> Address .�........... ....... � .... �f'1 ?. +. <br /> Contractor's Name . .......... .... .....License # �r1�" ,1�.... Phone cif .... . <br /> Installation will serve: V'r1"k&iience(Apartment House 13 Commercial ❑Trailer Court b <br /> 1 <br /> •�.--.Motel-Q-Ciiher-..:..::--•......:..........:............ �,. <br /> Nurtiber of living un"its:...._./_._ Number of bedrooms ... Garbage Grinder::-._...... ri <br /> # lot Slze ... .: t. .:�:: �.............:... <br /> Water Supply: Public System and name ...................................... W ... :.f..�rte .... ° ! . FP i <br /> ...... .. _. .. Private <br /> vale <br /> Character of soil to a depth of 3 feet: Sand Silt ) Cla F '� i • ` <br /> P ❑ ❑ l y Peat❑ Sandy Loam�} Clay.Loam❑ <br /> ,•. „_ <br /> Hardpan` j v Adobe Fill MaterialI­ <br /> _If yes,type r ........ °f <br /> {Plot pion, showing size of lot, location of system Inrelation to wells, bulldings, etc. must be placed'on!reverse side.}�y <br /> NEW INSTALLATION: {No septic tank or seepage pimitted if public[ � SEPTIC TANK Size...-•••••-..,•••.sewer,lsauailable within 200 feet,} <br /> t per <br /> PACKAGE TREATMENT x* ] ..... � . Liquid Depth .......................... <br /> Capacity --- ------------ - Type ........... Material---.:.r :... ...... a �./.........:... No Co4mpdrtments ...................... 1 <br /> i I / 144 <br /> 1 <br /> Distance. to nearest: Well .... .........:................Foundation _......... ........... Prop. Line ....................... <br /> LEACHING LINE [ J No. of Lines ........................ Length of each line............................ Total Length- <br /> . .°_. <br /> 'D' Box :.._e ...... Type Filter Material Depth .Filter Material ... �................. <br /> Distance to nearest; We <br /> ..... ...... ............ Foundation .............. <br /> H Properly t_L_Ine .............. <br /> : <br /> SEEPAGE PIT -----_---- Diameter i " Nii�ber".::.._.'":`:~~�.—— .Rock Filled Yes ❑ No i❑ <br /> I l <br /> Water Table Depth Rock Size ... 7. <br /> k 1i <br /> Distance to.nearest: Well . .foundation .. Prop. Line;................ <br /> ! wi <br /> REPAIR/ADDIflON(Prev. Sani#ation. Permit ........ ........ ...._:...... :•-...... Date ........;......I..................} i <br /> Septic Tank (Specify Requirements). ........._.:4.......... . . .... ........... ............. ...o .l <br /> 4_ x ; +� i <br /> --•••.....�_......•-- <br /> Disposal Field ISpeeify Requirements) . ) <br /> It �EX 'r�__D r ......... . } <br /> -----------------------------------• i .----------- zs' - . P.................................. __................... <br /> i �- ----------------- <br /> ----------------- ........................ ...... ------ •-• ....................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that-th work will-bo-dona~in--accordance with`Sat JoaquinCounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or liven• <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of;the work for which this"permit is issued, 1 shall not employ any person In such manner <br /> as to become subject to WarkmanVCompensatlon laws of, California." <br /> Y� <br /> Signed ------------- ------------------ -- -------- <br /> --r- - _.._ Owner '' ! <br /> BY { _----- Title <br /> - ... tF ..' ._._ <br /> if other th wner) <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ ----------- ... DATE <br /> BUILDING PERMIT ISSUED _ _____ __ _ ____ - <br /> -------.-..DATE ............................... <br /> ADDITIONAL COMMENTS . ______ _______ -- ti - .. <br /> �j ........................•--•-----------.....---------._..__......_..I......_._..... <br /> ...-•......- <br /> .._._..-- ----------- -----•- - .•.... ..__.•..................._.._......... <br /> Final Inspection by: -•-- .• -- : ..._,Date .. ./.:. .: <br /> EH <br /> 13 2!a ' <br /> SA t JOAQUIN LOCAL HEALTH DISTRICT 3M <br />