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r=oR�oFl=ici: Usl": - <br /> APPLICATION FOR SANITATION PERMIT <br /> Perm7 <br /> (Complete in Triplicate) <br /> it No. ......... <br /> This Permit Expires T Year From Dae Issued 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 applicatiop is made 'n compliance with ty Ordinar�� 549 and existing Rules and Regulations. ? <br /> A 40V <br /> JOB ADDRESS/LOCATION/ .. E?.177 -AL,X'.� e ... <br /> CENSUS TRACT /... <br /> Owner's Name .-.... �...f11 �T. L eGh. : .........'... <br /> -• . ne .� <br /> l <br /> Address .-... V-16. -a City. ... F. .Ttt.7�1. <br /> Contractor's Nome .-$Js.. .� k' L _ S <br /> .. , ...-. Phone -�,.�.. .. ....!.._: ... <br /> - ......................License # -------•---........ � 6 <br /> Installation will serve: Residence JAPartm,ent House p Commercial-OTrafier Court, C] <br /> Number of livingunits:---,d...... Numbero Motel ❑drooms Ga.rba a Grinder :.. <br /> �e f <br /> 9 Lot Size ....... ................... , <br /> r <br /> Water Supply: Public System and name .....-•---.......--- - - ----------- -.--......7.....••. -..-..------- ❑ A <br /> Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat 0 Sandy Loam ❑ Clay Loamy" O <br /> ❑ o ❑ <br /> Hardpan Adobe Flit Material -.:......... if;yes,:type ........................ <br /> p <br /> (Plot pian, 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, ! t J <br /> PACKAGE TREATMENT [ ] SEPTIC TANKize...;... .... v . Liquid Depth _ ........... <br /> i Capacity �,�r Q........ Type -- qr -- Material - .... `No. Comportm6nts .. ............ . <br /> Distance to nearest: Well ------15Wr.....:.........Foundation ... �._ Prop. Line , ..___._.. . <br /> Or f <br /> LEACHING LINE No: of Lines --- --:----- Length f each line-- --:..-... Total Length - _. ........ <br /> D' Bax ..'-- ------- Type Filter"Material -• ---- -'-_-- - _-De th ` <br /> p ........ <br /> yP d p . Filter Material .......�.a ................... <br /> r <br /> Distance to nearest: Well Fo dation - -8_.;.__.._:-.._. Property Line.. . .... <br /> ................... <br /> l. <br /> SEEPAGE PIT Depth ---- - .....= Diameter . Number .:... .:....-:.:±Rock'Filled Yes No Q <br /> Water Table Depth __..__ , ....... ......:........Rock Size ----___.. ._-...... .. :.. ` <br /> Distance to:nearest:.Well .._-_.._______________Foundation 4 .-.-_..._ Prop. Line'..�-_............. <br /> � <br /> REPAIR/ADDITION(Prey. Sanitation.Permit t# ... Date ' <br /> Septic Tank (Specify Requirements) _....-_..I......... - - } . .................... a <br /> ------ - <br /> .Disposal Field (Specify Requirements) --.--.--_-- -...:..---•......:............•�-----:------:--�'_-_--• I <br /> _ ..R : <br /> ----------------------- <br /> ------......................................--....... ------------7 --------..-.-.-_....-----------------------------.-...... ................................. .....---.. i <br /> .. ------_----••--• .- r ..iii."'...._. ...............................:.......: <br /> (Draw existingand re u:red addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that- the work will be done in accordance with San Joaquin <br /> County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health�District. Home owner or iiceW. <br /> sed agents signature certifies the following:w <br /> "I certify that in the performance of the work for which this permit is'issued, I sha)i not employ ciny�person in such manner [ <br /> as to be e s leVtoark�na 's.Compensation Paws of Californid."". -- <br /> Si ned Owner <br /> ..... Title: .....:'....... ................By .................................... ..:............................. <br /> (if other than owner) <br /> F05AEPARTMENT USE ONLY <br /> .... . . . <br /> APPLICATION <br /> :-....,:.. . DATE .........:........ <br /> EPTED <br /> ...:.:. <br /> BUILDING PERMIT ISSUEDBY....:::...: ..:::......=.. = == = _::...-•-`-•---::. ..r:...... :.:.:.i::.... . DATE ..:....:. l <br /> ADDITIONAL COMMENTS ...............:.......,...._:......: = i <br /> .----••...... ...... .....• •-------- ............. ... . ... .----.. --..... _ ... ...... <br /> �� ---•• -. ----- -•-- -----. <br /> Final Inspection by s' 4.. ill :.-....:... Date. �Y 7 ............... <br /> a�SAN JOAQUIN LOCAL,HEALTH' DISTRIC'. <br />