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i FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br />......................................................;. [Complete In Triplicafe) Permit No. ... <br />.................................1............._......... <br /> ---•..............•-...._ This Permit Expires 1 Year From bat+Issued <br /> Date Issued . <br /> Application is hereby made to the San Joaquln Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> II—9 9 .!�S `V .. CENSUS TRACT JOB AQDRESSf LOCAYION ��_ ....... -- _.......-- <br /> Owner's Nome .... ...... F........... .- _ . = P .. - Phone................. .............. <br /> le <br /> Address .... .z�-�.�.. 5......__` --... S F_ ........ <br /> ............ <br /> -•--...... city ---- 4.5 .......... .....:....................... <br /> Contractor's name ....t .: .::.... .PEE7....... ...................................11cense Phone <br /> Installation will serve: Residence partmttit House fl Crimmercial` ]Trailer[cgrt <br /> IIMotel ❑Other .............................. _...... <br /> 3 � a4c� .�....Number of luring units:... " Number of bedrooms Garbage Grinder Lot Sixe __ <br /> Water Supply: Public System and name Private ®� { <br /> Character of roil to a depth of 3 feet: Sand❑ Silt❑ ClayPeat❑ Sandy Loa m'0 Cloy Loam d <br /> q Hardpan[} Adobe Fill Material .. . If yes;type............................ <br /> b= A <br /> (Plot plan, showing size of lot, location of system in relation to wellsYbuiidings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONt lNo septic tank or seep g6'pit permitted if public sewer is within 204 feet,J, �r <br /> PACKAGE TREATMENT [ ] II SEPTIC TANK Sixe- - - �............................ Liquid Depth ....,4..1­­.-- _..-- <br /> [apdcity _.lD� TypePa t Material.��-�-aNa. Compartments _' <br /> f{ ................ <br /> Distance to nearest: Well .� ..�©Q..{............ Foundation ..�,��.�._.. Prop. Line ..�.........�......, <br /> LEACHING LINT: ( No. of lines ...��................. Length of each line.- -� _`Fg'+_Aotol Length ....�?40.......... <br /> 'D' $ox� . � Type Filter Moterlai ..P....-.... .Depth Filter Material --._..�1rr,--•--•--••..................... <br /> Distance to nearest: Well .... undatIon',.: ... ..._. Property Line _ ...... <br /> SEEPAGE PIT ( ) Depth . Diameter ❑ C3 <br /> .-- ........._...... Nurnber _.._........................ Rock Fisted Yes No <br /> Water Table Depth .................................I.:tack Size ................................ <br /> 11 <br /> Distance to nearest, Well's.................................. :Foundation .................... Prop. Line ...................... <br /> REPAIRJADDITION{Prey. Sanitation Permit# .,'��.x ............................._PData ..................................1~ <br /> Septic Tank (Specify�Requirementsl .......... .......................................................... i <br /> DisposalField (Specify Requirements) .........................._.................... t?................._...� ...................... ............................... <br /> .._a' ........ ............... ................................----..........{ ••----...-----....-----._...................... <br /> ....: <br /> I'I............................................................• te. ...__ ... ............ .......................-- <br /> (Daw existingand valdel I <br /> [ hereby certifyfthar t I have prepared this application and that NO`wo�k1;41ri& done in'accordance with San JeaquIn <br /> i:ount4'bsd[nances, State Laws, and Ryles and RR�ulatlons of the Son Joaquin Local Health District.Home owner or licen- <br /> sed agents signature certifies the followings- <br /> "I certify that in the pe rmpnce of the work for which'thls permit Is Issued, I shall not employ any person in such manner <br /> as to become ect t ork s rape so an laws`of California." <br /> Signed'_ ......q .. .s.. ........... . Owner } <br /> 8y ................... �I......._. ........................... . i.`.sItle ................................................... �- i <br /> (If other than owner; <br /> I! FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ...:_.......... .. . ...._........._...._.................. DATE ....�P��. .................. <br /> .. <br /> BUILDING PERMIT ISSUED _'; .............................: . .......... ........_.....................................DATE -............ <br /> . . <br /> ADDITIONAL COMMENTS '" ....'.. i <br /> . .............. <br /> . . ..ri...e. ; �.............. ._..._..._.............................................................-- <br /> ...................,................ . !......_....__...... ...., ;!��.. ....................._.:_..:_....... ..._................................ _ t. <br />