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FOR.OFFICE-USE----. .�- <br /> ► _ I APPLICATION POR SANITAT16N PERMIT 4_ <br /> --......._-•- -----_- .._v....................... (Complete In Triplicate). <br /> Permit No. ..7.Y--/D 3 <br /> -- _ <br /> " � � bate issued <br /> r............ .......................:.......... !� Th is.PermitExpires 3 Year from Datetssued <br /> Application is hereby made to the San Joaquin local Health District for wipe permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules. aim Regulations: <br /> I 6t— <br /> JOB ADDRESS/ OCATIO %­�.....f ------ I <br /> NSUS TRACT ... !...........-•---.....: <br /> Owner's <br /> Name .......... <br /> ------ <br /> •--�-.-_ .. . .:................: ..........._........_........Phone . ..... _ .............. <br /> -- <br /> i f14 � ry <br /> Address _.._....... • -.. �r f: s Ci .... <br /> Contractor's Name .•-• --"------------- -�- - �......* ........................... # ............._.......... Phone l i <br /> ......,.--••--•--........ <br /> Installation will serve: Residence%Apartment House0 Commercial OTrailer Court 0 <br /> Motel.EJOtheri_ ...................... ....... <br /> : , :. <br /> Number of living units:..... ...:_ Number of 13edroomns E_Garbage Grihder ............ Lot Size �UU_.�( ...._.•....•.. <br /> Water Sul pply: Public System and name -•------•-••-- ....._-----•-------- ....� ......_................ . ..........._Private 19 t <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Gay .0 Peat❑ Sandy Loom ❑ Clay Loam Ej <br /> ;.Hardpan 0 Adobe ftr Fill Materiaif yes,type <br /> (Piot plan, showing size of lot, location of system 'in relation to wells, buildings, etc. must be plated on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if publlct�r is available within 400 feet,) + <br /> { <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ I Size....................................... Liquid Depth � <br /> .....4.•--................ <br /> Capacity .................... Type --------. ------- Material€ ............... No. Compartments <br /> =ine; <br /> o .nearest: Well J. ..Foundations .... _ ............... . <br /> LEACHING ZINE [ } ...................... Length of each line4•_- ....--.--..:........... Totalength ...........................,y <br /> 'D' Box ........ Type Filter Material .................:..Depth .Filter Material ...... ......................... <br /> Distance to nearest: Well ------- --------------- Foundation ---..................... Property Line .................. !� i <br /> SEEPAGE: PIT [ j Depth -----=- ------ Diameter ------------__-- Number : ................_ ........ Rock Filled Yes ❑ No <br /> . r II. t p <br /> Water Table Depth -................................................Rock Size ....... <br /> Distance to nearest: Well ........................................Foundation ._ ...*•.. ...... Prop tine ........ <br /> REPAIR/ADDITION(Prev. Sanitation Pirimit.#;,rr. ----------------------••-••---•... Date---•-•--•- -------•-----:---=---1 <br /> Septic Tank [Specify Requirements) .. <br /> ........- ............... <br /> - <br /> Disposal Field (Specify Requirements) --•----- ..... ------ ••. --- -------•-•---• ............... <br /> . ,�...._ l �. p�-- - �-.-..r. --------------------------------- <br /> --------------------------------------------- ---------------------------- ........................... ........ .........--•••.................. <br /> (Draw existing and required addition on reverse side) - <br /> I hereby `certify that I have prepared this application and that the worir�.will be,dor 4 irdan a with San Joaquin <br /> County Ordinances, State Laws, acid Rules and Regulations of the San Jotquln Locat gealth.'District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> ":I certify that in the performance of the work for which this permit£€s Issued, I shall not employ any p rson in such manner <br /> a's to become subject to W It C ensation <br /> . laws of Califa <br /> rnta." <br /> ----------- Lgned - L/ � <br /> r <br /> By ----- ------------------•---- -- --------------...--•--------•--------------•-• -------- <br /> ---- --- 3itle _. s. ._...----•-------..__... ------. -.--- <br /> (If othe .t an owner) <br /> FQFR D M1E:N US4 ONLY <br /> APPLICATION ACCEPTED B - - I ----------.:DATEi .�: a <br /> - .......DATE ............................... ---......r.BUILDING PERMIT ISSUED ................................... <br /> . , . <br /> ADDITIONAL COMMENTS -------------- -------- ' <br /> --•-------- •---•- ------------------------------ ...................I....................------------------------ <br /> ------ •- -----. ...------------........... - •-•------------• ----------------------- ....._.- <br /> li _ <br /> . ----- ---- ------------------i ---. -------------------------- -. -------- -------------- ....... <br /> I - <br /> - :.. -- -- -- $" ---- - <br /> - L..- <br /> Final Inspection by: ...ev <br /> ---Date -. ....- .Z...�.-7.. ................. <br />' EH 13 21� 1-�6I3 5I SAN JOAQUIN LOCA HEAETi f DiSTR1CT 874 3M <br />