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—_-•++ems`-- - <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permitY- <br /> i (Complete in Triplicate} ? <br /> --------------------------- �4 Date Issued 3--1------- <br />--------------------- <br /> 3 - <br /> ------ �f <br />------ ----- This Permit Expires 1 Year From Date Issue <br /> ------------- <br /> _J <br /> ----- <br /> erm,;t to construct and, install the work herein <br /> Application is-hereby made to the San Joaquin Loyal Health bistrict for a p p <br /> tion .is_.made'incompliance with County Ordinance:No. X549 and- existing`Rules and Regu afi�ns: <br /> described. This applica �L&9, CENSUS TRACT (a <br /> --- -- --------- <br /> hone <br /> JOB ADDRESS/LOCA' - --------------- ----- --------- <br /> jOB <br /> Name - - __--__--ti City <br /> Address ---- --- ,� :Lieense # /$ 4 <br /> Contractor's Name .- <br /> artmen# House❑ Commercial Trailer Court ❑ 4 � <br /> Residence p ' <br /> Installation will serve: t <br /> ...-,.�...�.-.W..----•- ----_.�.�-_ Lot size ------------ ---- -------------- <br /> its: <br /> Garbage Grinder --- -- private �( ` <br /> f _ Number of .bedrooms - J <br /> Number of living units 4.- l u _�_ <br /> Y Water Supply: Public System and,name � y �Sandy Loam ❑ Clay,Loam: { <br /> r 1 r---"""F S�lfi❑ Clay ❑ Peat❑ - <br /> r. Sand'El l ----- <br /> Character of soil to a depth of 3 feet:. <br /> �} Na pan� Adobe ❑ Fill Material if Yes,type i <br /> .: .� <br /> i etc. must be placed on reverse side.} <br /> # f Qr1 <br /> y 1, <br /> buildings, <br /> i (plot p1an,Tshowtng <br /> size lot, ocation �f sysAm t relation <br /> ttedof public sewer is available within 200�feet,j f <br /> I � - <br /> NEW 1N57ALLAT{ON: (No septi tank or seepage pit <br /> p ! i�;�/ �, --------- Liquid Depth - r� `� <br /> SEPTICxTANK _-.__ Size-- - I <br /> PACKAGE TREATMENT [ f i I ` � Material No Compartments,,.-- €` <br /> Capacity -06 TYp� ! - f. y <br /> - Q Prop. Line -.-- <br /> 1 ----------�---Foundation ---�-------------- aQ.----------- <br /> + i Distance to nearest: Well _-- - ---- ---- <br /> k - - ��----- ---- - Total Lengfi� ----'"�'--- <br /> ��}} Length of each line ,• i <br /> LEACHING LINE [E+j� No. of lines ----G De th Filter Material <br /> p t-q ... <br /> Type Falter Material - - r Line Box - -----•--- <br /> fl----_- --- Property � - <br /> ` r -- - -� <br /> Distance to nearest: Weil -_--- +a --- �� Foundation - Rock Filled Yes`' No 0 <br /> p <br /> Number ------- <br /> SEEP Com_.L�l I _ _ Rock Size _•��-- ----'�---� - -=�''� � S t <br /> Water Table Depth ------------ --- --------- r t I-------- <br /> ell <br /> Prop. Line --..-----;- � <br /> --__._Foundafiion -.�-�'----- ------- <br /> I . <br /> Distance to nearest: Well -__-.-_-- O I i <br /> ------------ <br /> REPAIR/ADDITION(Prev. Sanitation Perm+ --------------------- .------- , <br /> ------- <br /> Septic Tank (Specify Require ents) -- - <br /> ecif Requirements? -- ------------- -------------•--------- ---- ---- ----- --------- ---- - - <br /> Disposal Field (Sp Y -=------- --- <br /> ---------------------------------------- <br /> --- -------------------- <br /> ----------------- <br /> ------- ------- r - --_ wired-oddit;on on reverse side) <br /> ' (Draw existing and req <br /> ---------------------------- - <br /> one in <br /> be d <br /> hat 1 have preph Son Joaquin <br /> this application and that thea Joaquin will Local Health District. Hometowner or I cen- <br /> t I hereby certify t #} I <br /> County Ordinances, State Laws, and Rules and Regulations of the eeson in such manner <br /> sed agents signature certifies the following: i <br /> "l certify that in the performance of the work for which this permit is issued, i shall not employ any p <br /> { <br /> as to become subject to Workman's Compensation laws of California Owner � <br /> Signed --------------- - -- -- -------------------- <br /> Title <br /> e 1 <br /> ---------------- ------ -- - <br /> ------------- - - <br /> (lf other than owner} <br /> FOR DEPARTMENT UST: ONLY <br /> ------ DATE - . ."L. °`7 ----- <br /> i DATE <br /> APPLICATION ACCEPTED BYf-.-- -- ------------------------ ------ <br /> BUILDING PERMIT ISSUED ---'------ _ <br /> ADDITIONAL COMMENTS `: -------- - � <br /> .�--� -- <br /> '--7 0--- <br /> --------------------------------------------- <br /> --- <br /> ------------------ <br /> -----�- ------- ate. <br /> by: - - <br /> ----------------------------- <br /> Final Inspection <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ .. , 's.a Rcv 5M <br />