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FOR OFFICE USE: . <br /> r <br /> APPLICATION FOR SANITATION PERMIT 2 �-��� <br /> ....w: w.. ....... .... .... .. ............ Permit No. <br /> - 4Cornplete In Triplicate) <br /> This permit Expires I Year From Date issued <br /> Date issued .3 3�• .7S— <br /> Application is hereby made to the San Joaquin Loral Health District for a permit to construct and install the work herein <br /> described. This application I anad In =p#!a ce wi unty Ordinance No. 549 and existing Rules and Regulations: <br /> y JOB OCAT <br /> ADDRESS/L �! <br /> C1?x�,l_. t-TACENSUS TRAPT <br /> Owner's Nam .. ...�1 ..-•---•_ pct; i�`[ fi•(_� .�t o <br /> .. _ Ph rye f� <br /> Address G�/L�T T' � / ' •�: ^ . <br /> �... �-� <br /> .... ......-•----....... City .._- ---...:�.... <br /> Contractor's Name <br /> - -••-•-••--=---•_..:...._._.license # •......... •------------- Phone ......................... <br /> Installation will serve. Residence©_Apartment:House C mmerciol#]Trailer Court 0 <br /> Motel 816her laf�t-LKX <br /> Number of living units:............ Number of bedrooms ...,"____Garbage Grinder ....... lot Size ..................... <br /> Water Supply: Public System and name _ •- •- <br /> : ....-------••---•• --... --�-•�•,v--;�--•--..._.-----••end <br /> ......:Private <br /> Character of soil to a depth of 3 feet: Sand Ej Silt Q Clay []�{.Peat Q y Loam ❑ Clay Loam 0 <br /> t, <br /> Hardpan 0 Adobe 0 Pill Misterial ........... if yes,type + <br /> r L x '-�� _ 1.. t <br /> (Plot plan, showing size of lot, location of system in relation to weds, buildings, etc. must be placed on reverse side:), <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer:is available within 200 feet,((v- + N <br /> PACKAGE TREATMENT SEPTIC TANK{ ] Liquid Depth <br /> Size •. :e::.. : .:. <br /> .__..:•----•-•-•-•-• -•-------------- -- <br /> Capacity -._------------_- Type •.----• 4'Mater€al.-_-" .......... <br /> No. Compartments ..................` ...� <br /> Distance to nearest: Well ..--•--------I._ Pounda on _. op Line Z <br /> P <br /> LEACHING LINE [ No. of Lines ________________________ Length of each line._..__.. __._..::.._....._.. Total"lT-7-h <br /> V Box ............ Type Filter Material ......_..............Depth Filter Material IrA �• <br /> ............................... <br /> Distance to nearest: ,Well-,----t........... l � "`"`-`-•' <br /> Foundation .......:F.............. Property Line .A-i... <br /> SEEPAGE PIT -__ Diameter . Number Rock Filled Y'4',] No i j <br /> --...�.._ E 1 Depth ................ --•-••-•------• <br /> ' Q <br /> Water,Table-Depth = ---- t.. --- - - Rock Sixe <br /> -------------•._.._..:_.. ...... .......................... <br /> Distance to nearest:.Well .................. ......................Foundation ___: Prop. Line i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> •- Date <br /> Septic Tank (Specify Requirements} . -..L �t •771✓ `re 1--�rt�E'S <br /> - .... ........... :. :.... ........•-- <br />,. Disposal Field fSpecify Requirements) •..........................•-----•--••-•----- ------ ' <br /> ---•- ---------- --------------------------- ------------......-• ... F <br /> ---------------- <br /> ----------------------- <br /> (Draw required additionside) <br /> I hereby certify that I have prepared this application and thework will be done In accordance with San Joaquin' <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed _ <br /> agents signature certifies the following: t <br /> "1 certify_�th '-,,�the performance the ok for which this .permit is Issued, I shah not employ any person in such manner <br /> as o becom' e s I t to W rk n' Co ensatian Laws of California." <br /> f <br /> SigOwner <br /> $ ...----- k... ti. ..- .._. ------------------- --•------ <br /> Y �..-------•- ..-•--- . Title ,§�-_ - - <br /> ot er than owner) <br /> r •------------ .................... <br /> R EPARTMENT USE O Y <br /> APPLICATION ACCEPTED BY -- r DATE --------=--------..-- :. <br /> BUILDING PERMIT ISSUED ._.. <br /> • -------••--•-�-- - ------------------------------------------ <br /> •----•-• ----.._._DATE ...... ..............•---.._... ..........------ <br /> ADDITIONAL COMMENTS -------------------- <br /> ------• ---- ---------------•---- ......... ......- ....... ------_.-...---••- •-- ... <br /> Final Inspection by: _.---- <br /> p •---�------ . _..__ _. - --- <br /> .........................•--------.._..----._...---....- --••-------•.-.._-Date __.._-_��- ./`�._ .?f�:::�-------��-- - <br /> Ell 13 2l# 1-68 'Rev. S JOAQUIN LOCAL HEALTH DISTRICT i` <br />