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OFFICE E: APPLICATION FOR SANITATION PERM" <br /> Permit No. -T....... <br /> ..............................' tcomplete in Triplicate) <br /> ry _ _ Da issued <br /> Date <br /> This Permit Expires 1 Year From Date Issue <br />......................................................... <br /> E <br /> Istruct and <br /> Application is hereby made to the San Joaquin Local <br /> wiHh Cou©ytordinance <br /> rNo. 549 and exi song Rules#andall �Regurmit to confationa herein <br /> described. This application is made in comp o <br /> F .... <br /> ................CENSliS TRACT ....,....,.. <br /> JOB ADDRESS/LOCATION ..f ..--. F, n <br /> � <br /> Phone21 W <br /> l y <br /> Owner's Name ........................ <br /> ••-•----...-•-... ..........._...... .........h <br /> City �. . .... <br /> 3. <br /> Address . ..-..... .....h.6:9.,7..-. <br /> .....--.... � <br /> cense !f:+ : , .. Phone <br /> Contractor's Name .............��.�-�,t•".��•'J�1�.�-..`�..�.�.i'.t.S'. • <br /> Installation will serve: Residence O(Apartment House] Commercial Trailer Court , <br /> �. ! <br /> Motel ❑Other ................................ <br /> Number of living units:-..-. <br /> Number of bedrooms -. Garbs a Grinder ............ Lot Size .s�`�-••• • • •• - <br /> ��.� Private <br /> 0 <br /> Water Supply: Public System and name .......................................I... <br /> ,k . � <br /> Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay ❑ fl Clay Loam <br /> . Peat❑ , <br /> Sandy Loam <br /> Hardpan(] Adobe 0. Fill Material .......: . 1f yes;type ........ <br /> (Plot plan, showing size of lot, location of system in relation to,wells, <br /> buildings, etc. must be placed on reverse side.) <br /> �. <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet, <br /> Liquid Depth .......................... y <br /> ' SEPTIC TANK ] Size............................................... p <br /> i PACKAGE TREATMENT I ] ..............1� <br /> .... Material.;-=•---.__.-...-�_•--. NQ• Com artments ........ <br /> T ®................. <br /> Capacity ---•-------------- yp <br /> a <br /> Distance,to nearest Well Foundation ................I...... Prop, Line ..................... <br /> ----.---- 1; <br /> fLength of each line....-. :-.. Total Length ............................ U1 <br /> 1 � � No. of Lines .... <br /> 1 LEACHING LINE <br /> 'D' Box .......--_- Type Filter Material Depth Filter Ma#erial .:................................. <br /> ...... <br /> i Distance to nearest; Well .................... Foundation Property Line ....•••..................n <br /> Number .........._.-.,.._......... Rock Filled Yes ❑ No ❑F <br /> SEEPAGE PIT [ ] Depth . Diameter + <br /> ---�—� Rock.Size <br /> Water Table Depth _ ................................. L tins ........... . .......... <br /> Distance to nearest: Well .....foundation _-- ....._.......... Pop. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# . .....--•--- Date ......... <br /> ......--- ....__.... <br /> Septic Tank (Specify Requirements). ............. -....._.....-- j! _...._.. <br /> 7Ct3L' ...� <br /> ' a! Field S ci Requirement ••-- -� -_._,.J��x,�.�.ni'��L�-• --- j . <br /> Desp <br /> s e l Pf� fYi r[ �`.�. �. *l. C .. -..[.7" ...................................... .. <br /> �V. <br /> ----------------------------•-----•--••------•-•---•-- ---=•- --- ----- ----------------------- <br /> -- - �e work rev be donezin accordance with San Joaquin wil <br /> I hereby certify that I have prepared this application and that <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local He.OI&Aistrict. Home ewner or Ilcon- <br /> sed agents signature'certifies the following: person in such manner <br /> "I certify that in the performance of.the work for which this permit is issued. t shalt not employ any <br /> as to be a ruble . to orkman's Compen on taws of California." <br /> 4---,� t1S- C� <br /> Signed ? <br /> Title - 7 !/+1AT0.. ....--- ... . •.:-. <br /> (If other than owner) <br /> FOR DEPARTMt:NT SE LY <br /> 4 r . <br /> - � - --:DATE... cad-o�o�=�--�-•---'.............. <br /> APPLICATION ACCEPTED BY - -------------------•--------:------- ....---- . <br /> BUILDING PERMIT ISSUi D :...-='----T•--------- <br /> --- . ....-..DATE .... <br /> ADDITIONAL COMMENTS ----•-----•----------•------ ------------ - - -••----•-••-•-•-- ............... <br /> . ,.T_.-.i <br /> �. . •------- <br /> .......... -------- -----------•....................-- ---.:.-----•----•-------------------•-------=----•---- ........ <br /> - 8 M <br /> o�� <br /> --------- -------------------------------------------------------•-------...•--�-•---...-------------------•-------••---•- .--...--.-..Date ----- •---•..-....-..... .-...- . <br /> Finalinspection by: ........................... . ...... . ............ .....................=-........... ----- <br /> EH 13.24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALT ISTRICT �7h � <br />