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FOR OFFICE: USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> :..:............:: . ............. ..:` :...."`•_ _ lCompletein Triplicate) . -__ _Permit No. ... .. r <br /> Date <br /> d issued .�VA <br /> •••.•-•-~-••• ................ This PermitExpiras 1 YearFrorn DaHlsstted --• ` <br /> Application is hereby made to the San Joaquin 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 /> JOB <br /> JOB ADDRESS/LOCATION. ......./....... ac0r_r_ .............CENSUS TRACT <br /> Owner's Name ' _. .............. . ..................... Phone <br /> hone <br /> Address <br /> ��- ,,�- ----- .......;! ..... .....:sty �C .1�`�.�`.`� <br /> 4.Contractor's Name ---:-7•--k ................License ,1@` . Phone <br /> Installation will serve: !Residence bdApartment House{ Commercial O caller Court 0 <br /> rr Motel(]Other <br /> ..................................... �/ <br /> Number of living units:...... Number of bedr oms ._...._.Garbage Grinder __( -5:.. Lot Size 5V X Z 3 F <br /> /1 ------------------ <br /> Number <br /> ------ - <br /> Water Supply: Public System and name L �: ,•_-- �P <br /> . . ...........: .r.................................................... <br /> Private❑. � <br /> Character of soil to a depth o€3 feet: Sand Silto— Cla . `•^� <br /> 3 ❑ D Y ❑ `Peat�] Sandy loam {] Clay Loam j] <br /> Hardpan j] Adobe Fill Material ............If yes,type <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V <br /> NEW INSTALLATION: (Ido septic tank or"see'Page pit'permltted if public sewer Is available within 200 feet,! <br /> PACKAGE TREATMENT j SEPTIC TA1�ifiCSize....----------.......:....:....... ... ..... Liquid Depth ------- ............ <br /> ` - No. Compartmentsartments <br /> ....••................Capacity- 1fiType � C5f_ Material <br /> Distance. to'nearest: Well ....................................Foundatio <br /> _-- Prop. Line ---------------------. <br /> LEACHING LINE No. of Lines" _...:.....A—_- _--• Length of each 1ine7_ -- ,� ota1 Length . ... ....... <br /> "-: / <br /> 'D' Box ............. <br /> Ty .e.Fil#er Material p :..De th .Filter Material <br /> - - <br /> Distance to nearest: Well <br /> ..,...... foundation -- -..... Property Line ----- ....... <br /> Depth: Diameter 12- <br /> Number .............................. Rock„Filled Yes W No 0r <br /> Water Table Depth _...............................................Rock Size <br /> ........................ <br /> '. <br /> ' Distance to nearest: Well. .....................Founclatibn <br /> ........ Pray. Line 5 <br /> !EPAIR/ADDITION(Prev. Sanitation Permit# ............. .... .................. Date`..--__. <br /> Septic Tank (Specify Requirements) ......:............. ... ,� + , <br /> -•.......................................... - <br /> --­­.............. , <br /> Disposal 'Field (Specify Requirements) ---- --. - <br /> ------ --------------••----------= - <br /> .....--•----••---••••---•---------••-•--•-----_-..-•------ --------- -•---- ----------- ............_.. <br /> - •. <br /> I harsh cert! that l have prepared this application an _ . . <br /> (Draw existing and required addition on reverse side) -�• „� <br /> y p P pp and ,that the work-will be done in accordance with Sale Joaquin <br /> County Ordinances, State Laws,. and Rules and Regulations of the San Joaquin Local Health:District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the parlor ace of the worts for which this permit is Issued, i shall not employ any person in such manner <br /> as to becom subject to W r an's o e anon laws'of California.” ` <br /> _ _ <br /> ---. Owner a w. <br /> By ------------- --- - Ti#le <br /> I other than owner! <br /> FOR DEPARTMENT,-USE,ONLY. <br /> APPLICATION ACCEPTED .L3Y __--- t-•-- , <br /> -- ------------•---...... ....._....._......,._....._ DATE...,:.,.•'.7 .... �:: = <br /> BUILDING PERMIT ISSUED DATE - <br /> - - <br /> ----------•-- <br /> . --- <br /> ADD <br /> ITIONAL COMMENTS :................... <br /> ................... <br /> --- -- -.._ <br /> ..-------------- ----- --------------- --.._......-- <br /> ----- -- <br /> ---------•------------- ------------- <br /> _..---- --•------------- ----------------------•-- - -------I Inspection by: . <br /> -. ' <br /> -----•--------------- ---- ---- -�'?^-:�"-••-•.....................................:..-----._Date ..,---- �� -?F............ <br /> EH 13 2L 1-•613 lay. � - L� --� - --•--�;------•-------- <br /> 5AN 1 AQUIN LOCAL HEALTH DISTRICT gl�a , <br />