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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - <br /> Permit No. <br /> .........................•...... -----'(Complete In Triplicate) <br /> 1 Date Issued .--.-.....•••-•• I <br /> This Perlt Expires I Year From Date Issued <br /> P J <br /> Application is hereby made to the Son Joaquin Lbcal Health D;strict 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 /> ...............CENSUS TRACT ............:....�¢.--- <br /> JOB ADDRESS/LOCATION .._... � �_.y'j� .._.. �. ._,. _ w .Phonex�.................................... <br /> ' Name ..._....�....----p�. ..�...:.a-� i `"""`+'..� .... � .�........--- <br /> Owners .................................................. <br /> f City ..._.._ <br /> Address ..._......--L. .. ....- . ; ,. y on .. <br /> �.7.....`.. Ph a :. .. . <br /> � .........__ .. t Dose C:........License # •------•.:.............. '• � , <br /> Contractor s Name "--�'- -�•- <br /> Instaliatian will serve: Residence, rtment H ommerc€al'�Tra}!er Court 0 <br /> NhrMotel e . ._G. . <br /> ::. .:.... ..... ,.�.....c.. <br /> .., .l.�. <br /> ._...... <br /> ............. <br /> er <br /> _....__—Garbege Grind -_ . tot Size ... <br /> Number olving units------ .___- Number of bedrooms <br /> ) =a :rc � .Private <br /> ............ ......._ :):...:.:.. = <br /> Water Supply- Public S stem and name ................ .... .... - �' ❑ <br /> pp Y . Y <br /> _Sand "LdarFi Giay-tam <br /> Character of soil to a depth o?3 feet: Sand ] silt Ciayj❑ Peal Y,.w , . <br /> e .. .._........- <br /> Hardpan ❑ Adobe; FiII,Material ; E If y.�s,ty�p�,'V�� i <br /> lace .on.reverse side.] <br /> (Plot plan, showing size of lot, location of. system in relation,to.wells, buildings, etc. must be p t <br /> NEW INSTALLATION: IND septic tan or, see a it permitted if public seer is available within 200 feet,)• f r. <br /> Liquid Depth .. .................. <br /> r <br /> SEPTIC TANK�]� ...._ ......- - <br /> PACKAGE TREATMENT [ I S;ze. .....:.._•--•-•--•- ... <br /> l ........... <br /> ._�. <br /> - -�- � � - ������*1Vo.. Compartm nts <br /> E.._:..- ��E Material <br /> Capacity : TY;PB. . . ..( ... rev t .. <br /> a .;_11 le ._ Prop. Line - - ......... <br /> I Qi'stance'"to nearest: Well„R;--. -••••" <br /> Foundation <br /> -- .:__.. Length of each line:.__� ...... Toto Len th <br /> �N o Lines .-.. •---._...---•• ..:.......... <br /> LEACHING LINE�(��-� ---•.. ..... <br /> 91 Depth Filter Material .•---- •- f`" <br /> `D' Box L Type Filter,Materiol .......... P <br /> ,r :.. Foundation ID............... Property Liney -• <br /> f . <br /> R Distance to nearest. Well '• ,. +4 <br /> Iv,. '. -�`'`-: Rock Filled Y0 ❑ No 0 <br /> Depth .._ --+""�~Diame�o r ...---=-•-••--,. Number .......:.......... . • <br /> I' <br /> SEEPAGE PIT E 7 P --""..."•• <br /> f. 'p <br /> Water Table Depth ...------- "-••--•-------••• ... � t <br /> i.. .::........Rock size ......._.....---•-----.-. ..._ � <br /> Distance to nearest: Well ..........................�...............Foundation --. Prop�.line ...................... <br /> ! t i 11 Date .................................:j <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........••4----jjr•-- . . .. . <br /> :. .. ........................ ._.. .......I. <br /> Septic Tank (Specify Requirements) •••-•-•- --......I <br /> Disposal FieldS ecif Requirements)I p Y q t <br /> . ..'..,.. .- E a . . d .... ... <br /> ... ... <br /> .................. ....... ..••-_...__..__..... <br /> (Drd`k`-existin an'd'•required addition on reverse side) <br /> I hereby certify that l 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 loco{ Health District. Home owner or eer' <br /> sed agents signature certifies the following: .. <br /> "I certifythat in the performance they:work for which this perriit is issued, I shall not employ any person in such manner <br /> as to b co ubject o ma s. Compensation lows of CaIlfoEnla. <br /> Vii.._.....:.: owner <br /> Signed s...... ..f1�l�h�....••• .....__ t ........ <br /> . Title .........Q� .... .••...... <br /> _ <br /> (if other than ownerl <br /> FOR DEPARTMENT USE ONLY <br /> .( ._ . --DATE <br /> AP..PLICATION-ACCi"P-TED BY - :.........:..: = 4 <br /> y <br /> :._ : s� ��.� - <br /> ....'DATE. - -- <br /> .......... .�.. .. <br /> BUILDING .PERMIT ISSUED........:.:------------ <br /> _-ADDITIONAL COMMENTS r. ........ ........................ ... ...... . `.. : _ <br /> -� <br /> ...._. .. ..... .. ... fa 4 ,h.......... Data ... L�:;� r_•/% <br /> Final Inspecttbn-b ,, �:: .. - - -•� <br /> .w <br /> SA JOAQUINs LOCAL HEALTH DISTRICT <br /> . .. ... _. . �.� , .... .. .. ...�.. --� _ �- _. 7/72 3 M <br /> 1 'A 24 , -Ac ne.. KHA <br />