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bpz <br /> FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No---- <br /> Date Issued.-S"-_._l` <br /> .............................. This Permit Expires I Year From Date Issued <br /> ,cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> ,nis application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION__----------'3_�. _. ---------------------------r ' CENSUS TRACT. <br /> Owner's Name------------- t - t -_ry !,� ' '' / >^ �_5 / --------- <br /> --- 1-•C-- Phone. -------- <br /> Address----- ------------_-------------- ..: C-------.....- -- ------------------------------------City...A- 1--�------------- --------Zip------------- ---------------- <br /> Contractor's Name-------------- -- --- -----5�/ ------------------------------License #---------------------------Phone----------------- <br /> Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ <br /> Motel ❑ Other---- --------_--- <br /> Number of living units:-----------------Number of bedrooms---- ----Garbage Grinder------------Lot Size----------------------.--__-.__________._..___..__.____.._. <br /> Water Supply: Public System and name------------------------------------------------------------------------------------------ ---------------------------------------Private '' <br /> Character of soil to a depth of 3 feet: Sand tr' Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ 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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> PACKAGE TREATMENT j j SEPTIC TANK (•j" Size------------------------------------ --------------------Liquid Depth.-------------.------- <br /> Ca acs / p1`z <br /> Capacity -- r Type.__:, -' Material_:_; p <br /> 0 � � t-f- "-- - --_No. Compartments <br /> • <br /> Foundation__---`� -- -- <br /> Distance to nearest. Well_____�'�__:-- _ '-.. _______-_.____ Prop. <br /> LEACHING LINE ---------------Length of each line------_l 0 x-- - ------.Total Length ---_------.%- "-------------- <br /> 'D' Box/i/4�_-Type Filter Material---r__ _'_- ----.Depth Filter Material----------------/--___--_____------.----------•---'------ <br /> Distanceto nearest: Well---�--.:_--___ .----------.Foundation-------_,------------_---Property Line.:_. <br /> SEEPAGE PIT ( ] Depth----------------Diameter---------------------Number-------------------------------- Rock Filled Yes ❑ No <br /> Water Table Depth------------ ----------••--------- ----------------------Rock Size.............................------------------_ <br /> Distance to nearest: Well-------------------------------------------Foundation.................---------Prop, Line.-------............... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------------------------_Date--.--..-----------_-- -----__-..__] <br /> Septic Tank (Specify Requirements)------------ ------------ -• ---------------------•--------------.. .. <br /> Disposal Field (Specify Requirements)-------------------__ ------------------------------------ •----•- ---• <br /> -----------------------------------------------•--••------------------------------------- - ---------------------------------------------•----._,.... <br /> -------------- <br /> ------------------------- <br /> •------ <br /> •---------------------------------------- <br /> --------------------------------------------------------------------------- ----------------------------------------••-•----- <br /> {Draw existing and required addition on reverse side] <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Loral Health District, Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as <br /> to become sub_**"t to Workm n's Compensption laws of California." e <br /> , l <br /> Signed.. � c.: Owner -- <br /> By--------------------------------------------- --- :.��---------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY X---------------------------- -- --------------------------- -DATE..__.... ..,... .,,. <br /> "-.._ - -----------------7 ------------------------------ ----------- <br /> D1V1510N OF LAND NUMBER... DATE..... ..... ........ - <br /> ADDITIONAL COMMENTS--------------------------------------- I............... .... .....­. <br /> -------•-• -----•--------•---------------------------------- ---------------------------------------------------------•- •--------...---........... ............. <br /> Final Inspection by:..:. =.:- ----------- - = - - - - ------.-".-----•-"•----=---- pate........._.. <br /> EM1324 SAN JOAQUIN LOCAL HEALTH DISTRICT rss 2107 4M 7/7a <br />