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OR OFFICE USE: <br /> ` <br /> APPLICATION :FOR SANITATION PERMIT r <br /> 1?". ~( :mirl lAte in T-1 licate) 4 - Permit <br /> .•.....-...•., . <br /> .... .. --- ..•. .................. This Permit Expires 1 Year From Data Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and Install the work herein k <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulationsc <br /> JOB ADDRESS/LOCATION ... .. <br /> . _.. �. ....�-. �._.:........ ......CE _ <br /> ... SUS TRACT <br /> ............... <br /> ........... <br /> ......... .............:Owner's Name ...� .n- .----•--------.- .-.-•. Ph eS. 9 LD <br /> Address City . .sti _ f <br /> Y.. <br /> �. . = �., ��fE <br /> rug .•..............•-•-------.................._.Contractor's Norrie _ -------------------•___•----._license # S.Z.. _ .__ Phone- .Installation wiII serve: Reside-nce:aApar:tment_House fl_Commericials❑T.raller_Court ❑ . <br /> Motel []Other . = ---------• -- € <br /> ,.�f:,:Number of living units:-.I--------- Number_of bedrooms .3.-4,—Garbage Grinder ---_-------- lot Size ..............:........... . <br /> .. S l� ................ <br /> Water Supply: Public System and name ..............'' <br /> --• :•-:-Q=----�-----Y-�---------..0....-------•y----.:__...�---•-•---- ......_Private <br /> Character of soil too depth of 3 feet: Sand Silt 1-Cl6Peat Sand Loom ClayLoam <br /> p <br /> Hardpan❑ Adobe ❑ Fill m-aterial ............ if yes,type f <br /> (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (N6 septic`tank or seepage -pit permitted,if public sewer is available within 200 feet,) <br /> • PACKAGE TREATMENTI" <br /> [ l SEPTIC TANK� ) • ` , Size- Q--- ................... liquid Depth --�-•-----•--•--=--.----- <br /> ` Capacity Type :� ...................... <br /> 1MaterIol---Cam' -_ No. Compartments - •- -------- --- <br /> Distance to nearest: Well .-.�L�. ....::... .. ......Foundation .1h_-_...--................. Prop. Line .S L?__...--:---•_-. <br /> LI;ACHlN <br /> G LINE [ ) No. of lines 3_...---• --.__---... Length of each line.-To--------------------- Total Length �.�1�...____.---._------ i <br /> • i <br /> 'D' Box _I........_. Type Filter Material ..� 6.askDepth Filter Material - ........................•------•-.--,• <br /> r s - <br /> [. Distance to nearest: Well .L6.6............... foundation 9_,5!........._._... Property Line 5Ll.................. <br /> SEEPAGE PIT [ J Depth __4!.r-A-E..... Diameter ................ Number ------------ ............... Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ...........:.•-•-------------......:.­­-­-Rock Size............._................... <br /> - <br /> Distance to nearest: Well ................... ............ ....Foundation .......------------ Prop. Line --:= <br /> A <br /> REPAIR/ADDITION(Prev. Sanitation Permit t# --....................................•----- Date .................................. <br /> j s <br /> Septic Tank {Specify Requirements) t <br /> Disposal Field (Specify Requirements) ..... .....................................---...................... <br /> ...._... <br /> --------------------------'--------------------••---------------------- - --------•- ----- ------ - --------------*--------------- -.......--------------.....__.._..-------------- •--•- <br /> (Draw existing and required addition on reverse side) <br /> I 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 Isocal Health District. Horne owner or (icon- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to:become subject to Workman's Compensation laws of California.,, <br /> Signed .... •-------------------•--------=-------------•-- ............... Owner <br /> By --------••--.. <br /> (If other than owner) <br /> . f R DEPARTMENT USE ONLY r <br /> APPLICATION ACCEPTED DATE.-- 8.x_/`-.7 ._----- <br /> ,BUILDING PERMIT ISSUEP,' ------ ----------•- DATE ... r. .. <br /> ADDITIONAL COMMENTS <br /> -------------- -----------------•---- ............................-...................... <br /> ............I---------------•• <br /> Final lnspect�on by: .. ._._: .._ . ---Date ......... -------- <br /> EHF <br /> 13 2!t 1-68 Rev* 5M SAN. JOAQUIN OCAL HEALTH DISTRICT Bl�jl 3M <br />