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EOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> S � <br /> .7•• <br /> ..................,--..__---------------- ------ <br /> Permit No. .y.... .__.. <br /> ., _ - Acomplete in Triplicate), <br /> Date IssuedThis Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit. to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..�GD..f�_.. .� � -� CENSUS TRACT .............. ........... <br /> ,_ t._..........;................. <br /> Owner's Name � .�J._�_ �� �f` �..._ .e-b. lG .............:............ n .......... <br /> .......Phone ., .. ..�.... <br /> ' � <br /> Address .....li�.�DQ-.. _../.���!IL.�T-...------..._ ...............city ��._. :............ ... ....r....--- <br /> Contractor's Name ._. 7L�� -�GtJ� .. '�'�----•----•----•licensees (. -3 Phone • - <br /> t <br /> Installation will serve: Residence❑Apartment House Commercial'ElTraller Court 0 <br /> Motel ❑Other _. > W__E6I&-ROfOr= <br /> Number of living units Number of bedrooms Garbage Grinder Lot Size <br /> Water Supply: Public System and name ._. .............................Private <br /> .._ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> t Hardpan[] Adobe 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 204 feet, j <br /> SEPTIC TANK SizeAr_d�AC.?x_,�� .. <br /> ....... ...... Liquid Depth . .................PACKAGE TREATMENT � i <br /> [ ] ] <br /> Capacity3b0_0..._. T � TMaterial-- • _-- - -- No. Compartments ... .... - <br /> ... ... <br /> _.. Prop. Line .. <br /> Distance.to nearest. ............... ..•_._Foundation ._AP...--•-.•-- ,,{ <br /> ,t <br /> LEACHING LINE [ ] No.. of Lines _le_ --- - Length of each line...(®�P................ Total Length .,/ ._....._...� <br /> �41 <br /> V Box --• Type Fit r Material Depth Filter Material . ...... ...... <br /> Distance tonearest: //�------- foundation .... ............. Property Line .... ................. <br /> No <br /> SEEPAGE PIT { ] Depth _-.. ------..------ Diameter ----•--•-- ----- Number ........................ <br /> Rack Filled Yes ❑ 1] <br />�. Water Table Depth -------•._ --------- ..................Rock Size ................................ <br /> Distance to nearest: Well ....Foundation Prop. Line .................... <br /> -- <br /> I - <br /> RIEPAIR/ADDITION(Prev. Sanitation Permit# .........••---- -•-----•...-----•........... Date .-------••_ ----------•------• I <br /> Septic Tank (Specify Requirements).................... --------.-•..:......... ..................................................................................... <br /> Disposal Field (Specify Requir4ments[ ...... ............................... <br /> ----------­-------------­-------­-----­------- ----------•-••--•..................•....... ---------....------------............--............................._...................... <br /> .. <br /> f .......................................... <br /> !I {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.Dlstrlct. Home owner Or Iicen- <br /> i sed agents signature certifies the following: <br /> i "1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner <br /> # as to beco bject rkma 's Co pensation laws of California." <br /> 1 <br /> Signed -- - Owner <br /> BY ----------------------• --- ---_..... ...._ ✓` <br /> ---• ------- Title _. ._ ---- <br /> (if other than owner) <br /> FOR DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED BY - -- - ----;------< ----------------• - DATE <br /> ^� <br /> BUILDING PERMIT ISSUED r DATE l - <br /> ADDITIONAL COMMENTS _ _.i. ' �s�rs�,----- �_. . _ . � �-----� <br /> -•-- -- <br /> ---------- -------- •------------ -I---------------------- ---------------- ._.._ . --------.-............... ................ <br /> F ---------- <br /> ----------------- <br /> ..:............. ........................ <br /> _ <br /> _._-_-I____________________ <br /> _______________________ ------------------------- <br /> P <br /> _ __________'. ______ . <br /> Date. .. ----_----. <br /> r <br /> fina{ Inspection by: ..f _ .. ....... .. ................ <br /> EH 13 24 1-68 iZev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8711 3M <br />