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rN6.A9 sit t W%X V=1 <br /> APPLICATION FOR SANITATION PERMIT ..�....._yea <br /> (Capiet*In Tefpllcat*) <br /> ....................................................... mPermit No. ........... <br /> ...... ... <br /> 14 <br /> . ............................... ..... .. . ....7J This Permit Expires t Year From Date Issued Date <br /> Application is hereby evade to the San Joaquin Local Health District for a permit to constrict and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Reguiationsr <br /> JOB ADDRESS/LOCATTION ....70,34»::.-./. 1A3(4- . 4-: 104(L ............................CENSUS-TRACT-........... .......... <br /> Owner's Nampet` 24.4.1.....yy� . . !S CK. ..............................r. ................. .Phone .9m?l . .......... <br /> Address ......l.T ........../.l! I► Efl. .._ .�i�....................._City > ?±:..................... ... . .. ........ <br /> Contractor's ... ....... .....................License 7 ..... Phone .r. �3 . . <br /> Installation will serve, ResidencoWApartment House C] Commercial pTraller Court El <br /> 4 4 � <br /> Motel❑Other.'-•-------•.............•••--•--•.......... <br /> ' l.�1 ,, -li .�. <br /> Number of living units:..../.... Number!�of:bedrySpms. .:....Garbage Grinder ,c�D.. Lot Site .. .............. <br /> Water Supply, Public System and name . ./0g �¢. ...................................-.........................................Private ❑ <br /> Character of soil to a depth of 3 feet, Sand❑ Slit Q CIQy"C Peat 0"S6ndy Loam ❑ Clay Loom <br /> Hardpan 0 Adobe a 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 side.] <br /> NEW INSTALLATION: (No septic tank or seepage.-pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... <br /> Capacity ................. Type .................... Material...................... No. Compartments ...................... <br /> y - <br /> ,,''` "� ,• Distance to nearest: Well --•..---•--•........................Foundation ......................Prop.-lane ...................... <br /> LEACHING LINE ( ] No. of Lines _ _,-'.................. Length of each line............................ Total Length ............................� <br /> D' 96x-"".-..jj Type Filter Material ....................Depth Filter Material ............................................ <br /> • , Distance to niarest: Well ......................... Foundation ........................ Property line ....................... <br /> .-. ..:rr+ . 4 f 13 <br /> SEEPAGE PIT ( } Depth .................. Diameter ................ Number`...._..._._............._... Rock Filled Yes ❑ No Q <br /> I p, <br /> Water Table Depth ................................................Rock Size ............................. . fl�bb- <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Eine .....................yr° <br /> REPAIR/ADDITION(Prov. Sanitation Permit# .......................................... . Date . .................. <br /> .-.--•--•--..--) �• <br /> Septic Tank (Specify Requirements) ............. ....... . ....... <br /> D' sal Field (Specify ltequirs encs) ..... ..i .... ...................•-••--•--....--•-•-............................................_....I........_.......� <br /> -• 5..x.1. Sr:. ,3 " .;OF: ....................................................... ............................................. �.. <br /> ......................................................... ... f` ........... ................................._............... <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 with San Joaquin <br /> County Ordinances, State Laws, and Rules and.Regulations of the San Joaquin Local Health Distrid. Home owner.or lic*n- <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 employbay person In such manner <br /> as to became subject to Workman's Compensation laws of California." <br /> Signed .. `........... .......... Owner I <br /> By .-... ......•.......................... Title . ............... <br /> (If other than owner <br /> } FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED--BY ...................................'.:. .... DATE <br /> BUILDING PERMIT ISSUED ........................ .. .DATE <br /> ADDITIONAL COMMENTS - <br /> .................................. s ......-----•--•---....._.................................................._......................................................--- ........... <br /> • ....... .. .... . ......... .............. <br /> ....................................................... .. -- <br /> ...............................�' ­....... <br /> ......... <br /> ... <br /> ...... <br /> Final inspection by Date ....... ..�... .....-.. ..... .........• <br /> ................. .... .. . ........... •..•-----....... --•-••-----....................................-. <br /> E14 <br /> 13 21t 3-68 �v• SAN JOAQUI LOCAL HEALTH DISTRICT 8/7h 3M <br />