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ArrLv6AIIVn PUK SANITATION rERMIT <br /> ..........................................:... Permit No. ......J�-_.... <br /> (Complete in Triplicate) <br /> _....--.-=--•....:................•._.............. <br /> • - Date issued .+.�......._•�� <br /> This Permit Expires i Year From Date Issued <br /> jApplication is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 nd Istlnp Rules and Regutationst <br /> � Ll.. �Cf t<!!' .. ........... ........ TRACT ...•-�........ .._....... <br /> } JOB ADDRES$/LOCATIO �:: ,,,.,�/� ......... � c�-.... � <br /> I Owner's Name ....-- iCTyY� ', . �1....,r.�.'-••- Phone <br /> Address .. C��................................................City ..........................................__................................ <br /> Contractor's Name .................License# ........................ Phone.............................. <br /> Installation will serves Residence❑Apartment House❑Commercial❑Tral1w Court A <br /> I Mate! Other ' <br /> Number of living units....._.)--- Plumber of bedrooms Garbage Grinder .. n.. Lot Size .� � . <br /> Water Supply; Public System and name -....................................................._...........................................-----...P'lvate,� <br /> FCharacter of soiko a depth of 3 feet; Sand O Siit Q Clay Peat❑ Sandy Loam ❑ day loam ❑ <br /> Hardpan Q Adobe Q Fill Material ........4...If yes,type..........:................. <br /> IF (Piot plan, showing size of lot, location of system In relation to-wells, buildings, etc. must be placed on reverse side.) <br /> rr <br /> NEW INSTALLATIONt (No septic tank or see age pit permitted if public sewer is a�—� <br /> l within 200.feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size..... '.�'.'i`'.:. .. Liquid Depth .:........................ <br /> - Capacity,It -4 Type:�zr- -I�Glateriai.t.t7 +�s..... No. Compartments ....... ...... <br /> ....._..Faun lotion ._../�l�-.... Prop.Line .. <br /> Distance to nearest. Well �••.----7� <br /> LEACHING LINE No. of Lines ....._... ......... Length of each line .....fe ... Total Length ..1 . <br /> II• 4 <br /> 'D' Box i..... Type Filter Material ZG. .. " pth Filter,"terial ......, .. .` .. .. <br /> Distance to nearest: Well ..c No...�Q `Property Line ..... .�� -.•• <br /> � Rock FIlted Yes No <br /> - SiEPAGE PIT E ) Depth .................... Diameter .... ........... Number .._......................... ❑ <br /> f-, Water Table Depth .-----•.........................................Rock Size ................................ <br /> t ; 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 /> n ........................................................................•----........--._....__..... .................... ...... ...._... <br /> ...........:... .................................................... .......................---••--•................................•--------• -------•---•-- .._._..---••-•---......_...................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San ;Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or llten-� <br /> sed agents signature certifies the following: <br /> °°i terrify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> t as to become sur )a t to Workman's Compensation laws of California." <br /> $:fined . -.... . <br /> .+:4�...................... Owner <br /> �� By -.............................................:...:......_..__.... .......... Jitle ..............-•••.....................................:. .............. <br /> (If other than owner) .' <br /> FOR DEPARTMENT USE ONLY <br /> x. APPLICATION ACCEPTED BY .-.... .......... . ........... ................................. DATE <br /> _} BUILDING PERMIT ISSUED ....... .............-DATE - <br /> ADDITIONAL COMMENTS1&— /-z ..7i6..... dfa :.+ '- ? .:u P` - ... !c.. .. n'.....�•-... -•.• .............. <br /> -. ..---•.................................. ............................. ........................ ................----._.........................-•-- <br /> ...... ...... <br /> .. .. ............... . <br /> ............. <br /> .............. <br /> ..................................... <br /> ..... <br /> .. <br /> .. <br /> ...... <br /> ........ <br /> .... <br /> .. <br /> .......... <br /> ......... <br /> ... <br /> —5 .... ............................. . ._.......--...------- --....................••--• ........--••••---... _------.-..-...... .. .... ... ...�` . <br /> Final Inspection 6y: ....... ...:.... ........................................................... bats f . <br /> EH 13 24 1-69 lfov, Sri . SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7� 3M <br /> r <br />