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-.FOR'OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------------------ Permit <br /> (Complete in Triplicate) <br /> ------ <br /> F Date <br /> k <br /> --------------------- ------ --- --- ._.-----__------- This Permit Expires 1 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 described. <br /> This application is made in compliance with County Ordinan a No. 549 and existing Rules and Regulations: I <br /> ---1�--- ---`_�------------- ----------- ------ <br /> t- <br /> JOB ADDRESS/LOCATION-/�---�--L.-,�_,;A041---- ------- CENSUS TRACT.------------------------------- <br /> Owner's Name .�.ri .-,r"� -_-_ '—�--_--___ -Ph � C� <br /> �� Awa / <br /> Address"lLcl�5,r6. �d -------------- -- -.CiN. <br /> ty - Zip <br /> Contractor's',Name-- ----- ' t- -- =------`------=,---------.-- License #_ _Phone-, ------- <br /> =- ' <br /> Installation will serve: sides a Apartment House ❑'_Commercial ❑ Trailer Court ❑ <br /> t p r Motel Other: € <br /> Number of.living units: -------I __Numbe"r.of bedrooms��' _._Glidg Grinder. - Lot_ e --------- -- <br /> ii <br /> Water Supply: Public System and nam ? -- "- ----- ------ - °€ ;---------------------- <br /> Character <br /> --------- -__.Character of soil to a depth of 3 feet: Sand lilt _1`t lays❑ PePeat 0 nc y,Lo m E] Cla.y,L•oarh•❑� r ' <br /> 1 Hardpan ❑ Adobe:❑ Fillf V�ateri,a�� -If yes, type -__ _-± ---------------II . <br /> [Plot plan, showing size of lot location of system�-irn relation to'wells, buiidings,Fetc. must be placg*h reverse side.) =t <br /> NEW INSTALLATION: (No-S-eptic tank or seepage pit permitted if public sewer isc64ail <br /> able within 200 feet,) <br /> PACKAGE TREATMENT j ] SEPTIC,TANK *Size--- '---�1 �/� '�{ F'--- -----`----' -- quid Depth--------------------------- <br /> Pe- <br /> ! ; - i4 <br /> Ca.pacity� �. _ - Material :--No. Compartments,- . `- -----------------Gi <br /> Disfnce.to nearest: Well- --------------- rro ndation L6�� ---Prop. Line/- # <br /> --:---- <br /> 9 /a� '. t <br /> .. . ::: .: :-.Len- th of each line._..- ©_9i t ' _. / g <br /> LEACHING LINE. No. 4',Lines:_ Total Len th <br /> D Box Type Filter Material-- Depth Filter,Material_. ___ ' <br /> K - - <br /> Distanceto nearest: _---Foundatlon.--. r Property Line __.-------------------- <br /> L <br /> SEEPAGE PIT [ ] : "D F---------- Diameter--------------- ----Number--- -- _t___ ----- Rock Y s ❑ No E]Filled e <br /> 0.y ;.r -Water Table Depth----------------- ------ -------------------------------.Rock Size_------------------------------------------77 <br /> ., --- i k <br /> = :=Foundation------------------ -.Prop. Line ---------------- <br /> ' - --- --- ------ > <br /> REPAIR/ADDITION [Prev.DSlanitation Pepmit#Wel _.__ _ _________..___. -----------____.Date _-:"_:__.:. ) <br /> Septic Tank [5 ecif Re uirements)-_.Y ----------------------- --- - - - --------------------- <br /> P P Y' q <br /> Disposal Field (Specify Requirements)----.---------------- - = '; ----------------- <br /> ------------- - <br /> ------------------ <br /> ------------------------------- ----= ----- --------------------------------------------------- - - <br /> ---------------------------- <br /> ---------------------------------------------------' : -- ----- = <br /> s {Draw existing and required addition on reverse side) . <br /> hereby.certify that I have.prepared this application and that-the-work-willYbe done inaccordancewith San 'Joaq n C u--\, <br /> Ordinances,. State Laws; and Rules and Regulations of the San:Joaquin.Local"Health District, Home owner or licensed age . <br /> signature certifies the following: ) <br /> "I Certify that in 'dive perforriarice of the work f6r'whi6 this permit is issued, I shall not employ any person in such manner as <br /> .to become subject to Workman's Compensation,laws of California." , <br /> Signed__ � i --------------------- - - <br /> ���„� <br /> B x =--- <br /> Y , - ---- --.Title _; '- Y - 4 <br /> (If other than owner) 1I <br /> FOR DEPARTMENT USE ONLY'., <br /> APPLICATION ACCEPTED'BY = 3Y . - a �.------------------DATE. �� --- <br /> - ----------------- <br /> DIVISION OF LAND NUMBER--------------=----- ------ = ----------------- ----------------------------------------DATE.--------------- <br /> ------. .. <br /> ADDITIONALCOMMENTS-------- ---------- ---- --------- -----------------:--------------------- --------------- --------------------- ----------------------- ---------- ------- <br /> ------- ------------------------------------------------- ------- ----------------=----------------- -------------------------------------------------------------------------------------------- <br /> - - - <br /> - <br /> - - : -=_---------------- <br /> ------------- ----- ---=- ------------------------------------------ ~Date .--------------------- -- ---------------------------- ------------------------------------------- <br /> ------------- <br /> Final Inspection - <br /> I 7 <br /> E!1 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 21e77 eEv 3M <br /> I <br />