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`K FOR OFFICE USE: t <br /> ORJ APPLICATION FOR SANITATION PERMIT <br /> ..��:.........r.................................... <br /> .. Permit No. T................ <br /> lCompfete in Triplicate <br /> This Permit Expires i Year From Date issued Date <br /> Application Is hereby made to the San .Joaquin Local Health District for a permit to constntef and Install the work herein <br /> described. This application is made In compliance with County Or inance No. 549 and existing Rules and Regulations: <br /> f , <br /> JOB ADDRESS OCATION . HL13. . <br /> /L .... .. _�.�f�l/.n'.....�!s...... ..�..el:s�-.. ��.. ..CENSUS T ,�f' . <br /> Owner's Name , ��t. rr ... _ .t`_'.�/' .1P.�.........................I............. ........ .............Phone ....... . .../-p--may... <br /> K ......... / �.. ".. <br /> Address ..................I._..........�?.. (cel- Ir - --�.......City . r ' .. --- ......_........................ t <br /> Contractor's Name ................................. .... .....................................License # ........................ Phone ----- ....... ........ <br /> C�APa�t . <br /> installation will serve: Residence House 10 Commercial 0, Trader Carat ❑ <br /> Motel❑Other F <br /> Number of living units:....... ... Number of bedrooms .... .....Garbage Grinder ............ Lot SIse f.. �. .�:70e)f.. 3C.tZ? " <br /> Water Supply: Public System and name .......................... ............................._................................................... <br /> PrlvaM <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt Q Clay [3 Peat❑ Sandy Loam{] day Loam. . <br /> —'�Hardpan-❑Adobe-❑-Fill-Materiol==�, <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: f No septic tank or go pit permitter! if lvpic sewer tillable within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK SI e ... 4� .... Liquid Depth <br /> Capacity : . . Type ateriai... X1.4........ No.-Compartments ..sem+. <br /> gyp' -�' <br /> Distance Yo nearest: Well .......� . ..........Foundation .a. .7 ....... Prop. Line. .... <br /> LEACHING LINE [ ] No' of linei ........................ Length of each line............................. Total Length ........... <br /> sel—, lclarla 'D' B x,............ Type Filter Material ....................Depth Filter Material .......................................... <br /> Distance to`nearests Well ........................ Foundation ........................ Property Line .............-........ <br /> SEEPAGE PIT [ p Depth .......! .......... Diameter ................ Number ............................ Rock Filled. Yes C) . No <br /> Water Table Depth .... ..........................................:.Rock Size ................................ , <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line .....................� <br /> i <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ...........................I <br /> Septic Tank (Specify-Requirements) ............ ''�� ..... .. ......... <br /> . .. ........ .�, , <br /> Disposal Field (Specify"'Requlrement:) ..........!:.... ................ ' '_................... <br /> .. ............................. ... ............................................... - '......_.....,.................................................................. <br /> ... .~ ---------------------------- <br /> I <br /> _. .._ '.`.: ............... ... .a ... .. , <br />�- — "� ����^�`{Dipw existing and regsslreif cdditlon cri ravers�t-side]' •- - <br /> i hereby certi"t I have prepared this application and that the work will be done In accordance with Son Joaquin <br /> mow., <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liter- t <br /> sad agents signature eertifiei the following: <br /> "4 certify that In the performance of the work for which this permit Is Issued, I shelf not employ any person in such manner =, <br /> as to becomes ect to War en'sMr7 <br /> onsatlon ws of California," r <br /> j <br /> Signed <br /> . ...... .- •..................................... Owner <br /> By ................... .. ..------........-•----. ............................. <br /> ----•........................ Xitie .................... ................................ . <br /> : <br /> (if other tfian own } . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... CST # <br /> ............. -•---- ---...................- ................ .. DATE ...�..�...i��..........: <br /> BUILDING PERMIT ISSUED ... ..//..:. .. ........... ...... .I........... :. .. ._....... ............- ..DATE.... ............. a <br /> ADDITIONAL COMMENTS - /�? 6.... - `' <br /> ....................... ............... .. * � ....d' .. e.=. � <br /> . . . r �.......... <br /> f. . ......... . ,rte.......... <br /> b : a <br /> Final Inspection <br /> ........-------------------------­- <br /> ... ...............•..... -*...........-----......---..Date -- ��: . .t• i <br /> �3 24 1--613 Hov. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h <br />