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R.........f 01110E USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> :.........;ti..:... ...� ,.. .... (Completein Trlplicam) ,. _ Permit Na. ...... <br /> -• <br /> . ©ate Issued <br /> Phis Permit Expires 1 Year t" Date lssued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein <br /> ' described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .__.. .. <br /> - ...,..._.._ _..._ �:..... =fi r-., . CENSUS TRACT <br /> Owner's Name ._ .. M .._.. .:.�. -- .:.__.., Phone! -....._....... -• <br /> Address ......... - --- ------ "I . <br /> - -------------­-- ................. ......... <br /> Contractor's Name .....: ..... - .License #� _ Phone . <br /> ! <br /> Installation will serve: Residence Pq Apartment House C3 Co:aime►cial OTraller Court <br /> Motel ❑Other <br /> Number of riving unifs:_..-/------ Number of bedrooms .... <br /> Garbage Grinder_ _ ./,-_ Lot Size 1sl..._":' l �. <br /> 'Water=Supply: Public System-and name ........_ ._... . <br /> .............---.----------:: - -- - •- Private <br /> Character of soli to a depth of 3,feet: Sad Silt C3- \-Clay Q'- Peat,-0a loam Ctay Loam 0 <br /> HQtdpon U Adobe fl',Fill Moterlal ._,�2 � <br /> .... ....:....... <br /> y ,' <br /> Mot pian, showing size of lot, location of systemisi relation`!a welis,!bulldings, etc. must be placed on reverse'aide.) <br /> NEW.INSTALLATION: (No septic tank or seepage pit pert�nitted-i#� �ublic-§tower.is availabWwithin 200 feet,) <br /> PACKAGE TREATMENT .�( ] SEPTIC TAMC f ] Size,.. ..). (,'�$ ... .... Ucluld Depth ..H170.......... <br /> Capacity _ . .aL _- __ YPe- .1' jaterial. . ... ..-::�:.._.. No. .Compartments .................- �f • y , <br /> Distance.to nearest: 11 ...../5.1.Q..:................Foundation__ Q `f. Prop. Line . ..> .� <br /> .... . --•---...... <br /> l€ACHING LINE [ } No. of Lines _'Al-----•----_-.: Length r f each line. 241 ._.... ... Total Length ...� 30:.......__.. <br /> 'D' Box .... Type Filter Material'"" Depth .Filter Material ..../ '-- ....................... <br /> Distance tonearest, Well SOD ' <br /> _______ Foundation .....%,c? Property Line ...... <br /> SEEPAGE PIT [ Depth ......��:._..... Diameter ........... .... Number ............................. Rock Filled Yes p No {]� <br /> Water Tabls=Depth .Rock Size ..:.... :: <br /> - ....... <br /> Distance to nearest: Well ..............Foundation Prop. Line <br /> y r . <br /> REPAIR ADDITION Prev. Sanitation Permit Date . <br /> 1 �` <br /> Septic Tank {Specify Requirements) ........---•--.._........:.................................................... <br /> ... ........:.............•._..............--- .........:..................... <br /> ,._.............:.... <br /> Disp3sal Field ISpecify Requirements) ................ <br /> ................................................................... <br /> ..•--------•---•---•••..._ . -----•- ----------- <br /> ....------•---- •--••------------- ------------------------•-----------•--•--••----•.....-••-••---••• <br /> 7 ........... ................. <br /> .. <br /> ---- ---------- ---••- ----- •. <br /> i <br /> �f (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son leaquln <br /> County,,Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hanceowner or licen- <br /> sed ogeiits si6nature iertifies the following: <br /> "l certiiry th€ e performonc e0CXVSQt=af <br /> ahik this permit Is issued, I shall not employ any person in such manner <br /> as to beta a su ' -t to Wor California." <br /> Signed / .... Owner <br /> - <br /> BY ............ , Title ---- ---- <br /> i - lif other-than owner} * ' <br /> FOR DEPARTMENT USE ONLY <br /> BUlLDI , <br /> APPLICATION ACCEPTED BY -,---• ---.-.--------..-='=:::=: '`" <br /> NG-PERMIT ISSUEDDAT€,-.. J`�r �J - <br /> ADDITIONAL COMMENTS --------------t_-.-.._...._.._........-_-- - <br /> ---------------DATE ............ .....'... _ <br /> ------- <br /> ---------------•----....----- -----I., ­­-­------------------ <br /> �� °.......... <br /> -- - ------------ �.'. <br /> . <br /> finol Inspection by: ------------------- - -_Date _..._.. 1 <br /> 13 21, 1-613 ` Rev. 5m SAN JOAQUIN LOCAs. HEALTH DISTRICT .„., 8/711 3M <br />