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FOR'OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> . : ... Permit No:T -�� <br /> .. .j �, ....- .- •. 1Catnpleh in Tripilwtel. _: �._ , . ._. _. .: . .. -... • q <br /> :. Date issued <br /> This Permit Expires 1 Year from Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein <br /> described, this application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> )_01 ?� ' .. <br /> ..........CENUTRACT ..................,JOB ADDRE5S/LOCATION. .. - .., . <br /> OwnersName ... ... . ......... ........._. ...................................;................. <br /> . <br /> Address ....... ©.Q...... .. .l... City <br /> ,�+ .. pp <br /> Contractor's Name /:/. - �1LJ :::.£...::...:.`:::...._.License <br /> .Installation will serve. Residence Apartment House] Commercial oTrailer Court � <br /> Motel.p Other............................................... <br /> Number of living units:..._.... Number of bedrooms _. .-».Garbage Grinder:.:/.:'..._ Lot Sine -----J�Q !�__................. <br /> �► <br /> Water Supply: Public System and name .. --,:. .............. .....-..............................-•-------...Private <br /> Character'of soul to a depth of 3 feet: Sand� Silt C3 Clay 0 Peat Q-- Sandy Lodm (3 Clay Loam <br /> 1] <br /> . Hardpan 0 Adobe 0 Fill Material _..... .tf Yes,�............................ <br /> • k <br /> (Piot plan,-showing size of 'tot, locations of system in relation to wells; buildings, etc. must be placed on revers@ side.) O <br /> NEW INSTALLATION: (No septic or seepage pit ,permitted if public sower is available within 200 feet,) <br /> p : <br /> `-PACKAGE TREATMENT [ TiC TANK;j ]. sin......l L.. ..U,., ..... <br /> ............... liquid Depth .....---...-. <br /> I ��U `�� <br /> Capacity !� �?�? _- Type tel!? .. Malariai..�' ..... No. Compartments ... ....... <br /> i Well _J�-00............. <br /> .Foundation .-�Q.�:........... Prop. Line __a.' ........: <br /> LEACH I]istance..to nearest. ..; ................... , <br /> . 4 i .t <br /> LEACHING LINE [ No. of Lines ..:...-- ---- Length of each line........ 0............. Tota! Length ...._Z: ........-•-- <br /> 'Q' Box ./..---.:. Type Filtar Material ..I _: .Depth .Filter Material .../2• i�- '............. <br />' I of ` f <br /> Distance to nearest: Well ..-:��................Foundation ......q.....: . .Property line ....9,: .=...... <br /> No Q �. <br /> SEEPAGE PIT [ � Depth �......---•.... Diameter ..........:..... Number ....... ..... Rock Filled. Yes � \p <br /> Water. Table Depth ........... ...................:.............hock Size ... -:.............--- - <br /> If <br /> .....---••- -Distance to nearest: Well ......... ........ . .r.........::.Foundatioh ...........•. Prop Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..... ............... Date ...... ...... <br />' Septic Tank (Specify Requirements) ----- <br /> - -- <br /> Disposal Field (Specify Requirements) ------------------ -- ..........._ <br /> j : <br /> •-• ..-..... <br /> .. <br /> __. ---•----•-- ........ <br /> . ............. .. .----- <br /> ... .............. <br /> f (Draw existing and required addition on i'everseside) <br /> ! hereby certify that I have prepared-this appilcatlon and- that the work,will.be4done Ia 'accordance with Satz ,Ioaggln <br /> County Ordinances, State Laws, and Rules and Regulations o#'•tits Sat!':#oaquint Local Health:District. Homo owner Or Ilale- <br /> sedagents signature certifies the Qlowing: <br /> "I certify that in the.performance of-the work-For which:this permit is issued,-i shall not employ any person In such manner <br /> as to become subject to Workman's Compensation;laws of California." ,. <br /> k Signed ------------- ' Ow r` <br /> 1,0 �7 e c: ------------ ......By <br /> (if.other than owner) ' <br /> _ OR D€PAR MENT USE ONLYf <br /> APPLICATION ACCEPTED BY _,--���._ . ..- <br /> DATA ..:. 1 <br /> BUILDING PERMIT ISSUED ----------------------------------------------- -- -------.......--------------,----•----- DATE ....................... ) .: <br /> ADDITIONALCOMMENTS ------------------------•--•..._-_---------------- -•----------------•---............._1111:..,------...-1.111--_....__.._._.....__.... ...............,... j <br /> --------------------------•------•----------------•- - ----------------------------------E -•--------- ----------------•......... <br /> � <br /> ------ ------1.111_.. <br /> - - •--------------- -------. -..---------,::_...._..-- ------- ----- ----------- ;.� -�-----y1 <br /> . ----------- <br /> ------------------------------------ <br /> Final inspection by- ---------- ✓... ... _-.. . -----------Date ----------------•--•---- -.......... <br /> - ------------- •----- ----1111-------111.1. . <br /> EH 13 24 1-C I3 faev. �f SAN JOAQU LOCAL HEALTH DISTRICT g/7)3 3M <br />