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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ................................•........................ <br /> ............. 4 <br /> {Complete in Tripllcatei <br /> - - <br /> ........................................... ................. <br /> ............... � date issue <br /> j This Permit Expires ]AYearFrom Date Issued <br /> •,._.._...•--•-• <br /> Application is hereby made to the'5an Joaquin local Health District for a permit to construct and Install the work herein <br /> ce with County Ordinance No: 549 and existing Rules and Regulations: <br /> described. This application is made in complian <br /> /+�e CENSUS TRACT <br /> i 2, 6_2 ........................................ <br /> JOB ADDRESS/LOCATION ...... ... ......... <br /> ............................ <br /> VLfi ��1.4!r''r .............. ....................Phone ....._..._,.. ................. <br /> Owner's Name .._..�.......r............... . .. ... _ ..._........._...:.....,-------.... <br /> �.z..G. ..._l!'1 f "lei- ........:.......... City ...X.$242..... ...-_.-........... <br /> Address . 9 ... <br /> ..... 3 �. .---- Phone <br /> Contractor's Name --- License ..Y-_�• ••..-6°•7•- <br /> Installation will. serve: Residence BlApartment House Commercial❑Trailer Court ❑ <br /> Motel ❑Other . <br /> r ;Number-of$edrooms _- ......Garbs a Grinder ....--- Lot Size ../�--- 5.res...:...............� <br /> Number of living units....1......i <br /> Water Supply: Public System and name -----•-• ...... ......................Private <br /> : . I y ❑ Peat❑ Sand Loom Clay Loam ❑ <br /> Character of soil to a depth of 3'feet: Sand�Sill Q clay Y i� <br /> i = Hardpan o Adobe 0" Fill Waterlal ..........•.If yes,type ................ .....I...... <br /> #Plot,plan, showing size of lot, location'of system in"relation to-wells, buildings, etc. must be placed on reverse sIile:y"- <br /> NEW INSTALLATION:__.,.'(No septic tahk,or seepage pit permitted if public sewer is available within 200 feet,1. <br /> ( PACKAGE TREATMENT I ] SEPTIC TANK 13 Size......:..............:... Liquid Depth <br /> r .... Material............... .. No. Compartments .. ........ <br /> Capacity� ...............� •- Type ................ -.... .. .........- <br /> 1 <br /> }. Distance. to nearest: Well ....................................Foundation ......................... Prop. Line _........... <br /> .......... <br /> * <br /> ' <br /> LEACHING LINE [ No. of Lines Length of each line......................... Total length ............................ <br /> D' Box T 'e filter Material .....Depth .Filter Material ................. <br /> ' Yip � ....:......... <br /> Distance to nearest: Well' ...... Foundation ........................ Property Line ....................••.. <br /> I <br /> SEEPAGE PIT f ' ' "'Depth ............ .. .... Diameter ................ Number .. ................... Rock Filled Yes ❑ No 0 <br /> Water Table Depth .......:.................................. ...Rock Size <br /> ' X u •Prop. Line <br /> Distonce�to nearest: Well ..............Foundation ........•----....... -- <br /> r* <br /> REPAIR/ADDITION(Preva Sanitation Permit :.....:................. Date •---•-•--.:...._._.:.... } <br /> Septic Tank #Specify Requirements) .......--.--+__----- - .......................y -.................... .............. : :.....:` -. ..._ <br /> - ..- <br /> Disposal Field (Specify Requirements) ...I-P--...'Z`!ts��c !!�..-..S!�-� Qrc� �?...�!.y_ ....._./......3�-.?i'.25--��........ <br /> ...•.. <br /> . <br /> D ' y �� �"� G 1 f n / D�s�-•__ oX ...............•--- ........., <br /> -------- ----- ------•... ._._._.-- ------••-•--. ... <br /> 4 . -•. ...... .......... ---..-:........................----............----- ............................................ .............. <br /> I (Draw existing'and'required addition on reverse sides <br /> l I hereby certify t a'iAcive prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State'Laws v dnd Rules and Regulations of the`San Joaquin local Health:District.Home owner or licen- <br /> sed agents signature certifies the following. = ` <br /> "I certify that in the performance of the work for which this permit Is issued, t shelf not employ any person in such manner <br /> I as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------------------------------•-- Owner <br /> �s-riB ------------------- -------------------- Title . �S <br /> By --If other than owner) r <br /> FOR D PARTMENT USE ONLY <br /> -- ,,..,_ '��_ ; -`----- ----- ---- -DATE.... ............. � --- <br /> APPLICATION ACCEPTED BY _....-. ..."--" " <br /> BUILDING PERMIT ISSUED ._.-----`� .......... ..---- . .....----.DATE ....: ........................... <br /> ADDITIONAL COMMENTS -------- ------•-_-- - --------- --..._.-. -------........:........................... <br /> ------------------- •-------•......----- --------------------------------......._.....-,-- .... ........................................-............ -------......---.............. <br /> r <br /> i <br /> .... <br /> ..........:................................•-------..--•----...... --------------•--------• <br /> ...................................• .. .... .. <br /> Final Inspection b J .Date .... -Z:�/..7-`.� ._... . <br /> EH 13 24 I-68 Rev. 5M , SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br />