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--�---- <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..�.--•-•-•---.._. <br /> .....................................:.. _-------•-- (Complete in Triplicate) <br /> �.,, .. _. W ..Date Issued .................... <br /> f� <br />.--,•---•..--.---•......................._...:..__..._.. k This Permltl:xplres 1 Year from Dot*Issued <br /> r( <br /> Application is hereby made to the Srein <br /> an Joaquin <br /> cwiHh Cou ealth District Ordinance permit <br /> and exl g Rulestalnd Regl the ula long- <br /> described. This application is madelin compliance <br /> r GE <br /> - `! �� ,:.�� � .................... N5LIS TRACT .......�� ..... <br /> JOB ADDRESVLOCATI N ._.... Y�1._ .... _.. �:...... ._...f..�................ <br /> I .....Phone ... .���..---.:..�...... <br /> .... <br /> Owner's Name .. ........................... �c <br /> .�'.� ,<� S�._. . . ... - �1--�.............------.:city ��� .... ' ...---..................... <br /> .... <br /> Address . . ........ Ph <br /> • _...License # ..:..................... ane <br /> Contractor's Name ----------------- .....__....---...-•------••• ----- { <br /> Installation will serve: Reside ce 0 Apartment House0 Commercial railer Court �] <br /> Motel ❑Other ........................... Cho <br /> Garbage Grinder Lot Size ..• <br /> Number of living units:...-.:..:__ Number of bedrooms ........ 9 <br /> Water Supply: Public System and name .- ..................... Private <br /> Character of soil to a depth of 3 feet: . Sand ❑ Silt Q Clay R Peat❑ Sandy Loam ❑ lay Loam;M d <br /> PP Y� i-4e i <br /> 4 <br /> Hardpan C] x, Adobe'❑° Fill Material ... ..... If yes,type <br /> .. <br /> (Plot pian, showing size of lot, location of system in relation-to wells, buildings, etc. must be placed on reverse side. i <br /> NEW INSTALLATION: (No septic tank or.seepage-pit-permitted if public sewer is available within 200 feet,l <br /> j. <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ I SIM..... .... ••. --- . ---... � Liquid Qepth .... <br /> .___ Type ._-. ateria .... - ---• No. Compartments ... �-•••-• <br /> - <br /> Capacity -- ••-- YP • -- ---• •- ` .. .... <br /> .... <br /> Distance.to nearest: Well _. ........... <br /> Foundation...................... Prop. Line . :.. <br /> -f-.._•.-__-.-. Length of each li ,/lJ- ............ Total Length ...... ...... <br /> LINT~ No. of Lines - ------ .. <br /> De th Filter Material .._...• I ...........r.... <br /> D' Box .._......... Type Filter Material P r <br /> Line ..... �• - '�{� <br /> Distance to nearest: Well ...../o�: <br /> ..---•-•• Foundation QLD •••• Property <br /> SEEPAGE PIT { ] Depth ---- --------- ----- Diameter <br /> Number --------------.............. Rock Filled Yes ❑ No <br /> Water Table Depth .........................Rock Size ............ ....•---.. ........ <br /> ..Distance to nearest: Well _• ....Foundation ............:....... Prop. Line ..._ ....._......----- <br /> .. ..-- Date ----------- --•-••------•-•--- <br /> REPAIR/ADDITION(Prev. Sanitation Permit�#` ....----••• ---------------- ----------------- <br /> .............._—............... <br /> Septic Tank (Specify Requirements) --------------------------------- ----------- - ........... <br /> ..._... � <br /> �- ._ .. J. <br /> pd _...=•--- -•... .... .. . ... ..5..._.._....._. <br /> r Y Re Disposal Field tSPecif Requirements) <br /> ,•..------- <br /> q 5 .. <br /> 4 ........................................ <br /> ___ <br /> ------------------ <br /> --_:__....__._____-__________ <br /> ____..-__._- -.___ _ ________ on reverse side <br /> _...............-. <br /> 1 _________________••--------- _ - - <br /> - (©raw existing and required addition i e <br /> 1 hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health;District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify thatalin he perfo mance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> a: .to bac to rkman's Compe at aws of California." <br /> t Signed f..- ---••---------- Owner <br /> --- --- ---- ---•---------- <br /> ..----------•-------- --------- line ---------- :... - - -=----- - ---- --•- ----•---- -----•-- ---------- <br /> (if other than owner) <br /> OR IYEPARTMENT USE ONLY . <br /> APPLICATION ACCEPTED BY __.__. . <br /> :-. DATE-: .I/ _/. ..'� ., :;_ <br /> BUILDING PERMIT' ISSUED -------- .. - .......... <br /> . _.. ._._R.----�-'---�-- � -----T--- <br /> ...............DATE -...__. ------- �........ ....... <br /> ADDITIONAL COMMENTS _-------- ------- ------ - ------.-------._._-------.._... <br /> .. .--------... .............. - •`--------•..__.._._ •-----•---------- ------- ..............------ ....._.._.. <br /> _..-- <br /> i - _..... .. _ �� '` ._..._._ .. --------Date //........ ................ <br /> ---_..... <br /> Final Inspection by: ------ .---•-••...................... <br /> 8�7� 3� <br /> Eli 13 A 1-68 Rev. 5M � SAN JOAQUIN LOCAL HEALTH DISTRICT <br />