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F <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMITa. <br /> .;.. `... ................................... Permit No. .7:�..�d...--- <br /> (Complete in Triplicate) <br /> .�......... <br /> �'. .Z3........ <br /> Date Issued ... .... . ........ ; <br /> ............... This Permit Expires 1 Year From Dot*Issued <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 ADDRESS/LOCATION <br /> CENSUS TRACT .......................... <br /> Owner's Nome KPLc-� S .....Itif+ka'FZ4T ..Phone <br /> r' .. .a�€�'_.��`7, -�?..• <br /> Address ....... „S.►.S.r.._ c..... . - u4ta-w1 ---------------------- City _.. SF}Go. ---.......-•----....--•--..............._._... <br /> Contractor's Name ...... .. f{2 '.s. - .- -r-_. ---.License # ��`F .`{��._ Phone <br /> Installation will serve_: Residence ❑ Apartment Ho seg[] Commercial ❑Trailer Court C] <br /> Motel ❑ Other <br /> Number of living' units:........... Number of bedrooms ... Grinder ...... Lot Size .... ........... <br /> Water Supply: Public System and name . .............. • ----- ...---------•• .---------_--•...---....`......------........----Private [ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay X 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, build'ings,'etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if-pu/blic sewer is available within 200 feet,) <br /> PACKAGE: TREATMENT ( ] SEPTIC TANK I j Size....------ TJ_Zz,, ........... Liquid Depth ---- ............ W <br /> Capacity*..�. -._i.. Type .T`r'y atenal-. _ . - No. Compartments -- ---------.• <br /> Distance to,nearest: Well .... ..............-----Foundation ....l®.. _....... Prop. Line .. .............. <br /> LEACHING LINE No. of Lines length of each line .... .-.-....-... Total Length __.c ................ <br /> 'D' Box . ..... Type Filter Material .: fie ----Depth filter Material ------------------------------- <br /> Distance to nearest: Well Foundation IQ-'17...... Property Line ___� G <br /> _o. �� <br /> SEEPAGE PIT Depth .. --- ..... Diameter -. ..__...___ Number Rock Filled Yes No <br /> Water Table Depth - - ------------------Rock Size ...�.{ �..-------_- <br /> Distance to nearest: V+/ell _._... ted.....................Foundation rte... ....... Prop. Line _. .........._._._. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- --------- Date __..---------.----.-_------------1 <br /> Septic Tank (Specify Requirements) ...`. ,......:ti.---------- -- ....................................... ............... <br /> DisposalField (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 Son Joaquin <br /> County Ordinances, State laws, and Rules and.Regulations of the San Joaquin Local Health District. Nome owner or licon- <br /> sed agents 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 <br /> as to become subject to Workman's Compensation laws of California. <br /> Signed ...... -- -------- .. -----•----••--------------- ------------------ Owner <br /> Title . .. ............. <br /> (If other than owner <br /> FOR DEPARTMENT USE<ONLY <br /> APPLICATION ACCEPTED BY __ ................ DATE ... . _. .......... -2.3... <br /> BUILDINGPERMIT ISSUED - ..................•........... ..............DATE ...... . ......_ .............. <br /> I' ADDITIONAL COMMENTS .-•- .... .... ..... av -23• ��5 - <br /> k ---- --- .......... --------------•.-- . ............. ...................... ---- <br /> f <br /> -.._... <br /> Final Inspection by; C P F .......---?- ... --- • ---- -------- u...f .__.Date ..��.Z` ....................... .. <br /> I SAN JOAQUIN LOCAL HEALTH DISTRICT ' <br />