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---- <br /> FiCE Use, APPLICATION FOR SANITATION PERMR � - ,Y 71 <br /> Permit leo. . ...-... <br /> ..._.................................................... (Complete in Triplicate) <br /> Date issued -.......I......... <br /> ............................... <br /> This Permit Expires T Year From Date 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 Ith County rdinance No. 5A?And eCUS <br /> Rules and Regulations: <br /> " -�''�`1�,�.(1.. ......_.... TRACT .......................... <br /> JOB ADDRESSAOCAT ON C ,�? ..... <br /> _.. _.._ ._ <br /> Phone .....................•..........._.. <br /> Owner's (`tame <br /> �/ _...City .. _ <br /> Address . .� � ._ .. .1 . $'hone <br /> Contractor's Name ._ _ `�irc3��-*��-•............................... <br /> .....License# <br /> C/ E _ _ <br /> installation will serve= ResidenceXApartment House Commercial{]Trailer Caurt 0 <br /> ............. ............. — <br /> ,Motel ❑Other_ rte.••--�•_--•--. - <br /> - - N ' tot Size <br /> - --- -`' f c�- Garbage Grinder ......----•------•---- <br /> _ y�Number of living units=- -d_-_._ Number of.beiroams ._._..._... g ..._........ ............. <br /> and ........._._...--- Prtvata,� <br /> Water Supply= Public System name ..._..-:............... --------- <br /> ____ <br /> I Peat Sandy Loam{3 Clay Loam <br /> Character of soil to a depth of 3 feet: Sand Silt Q Clay ❑ ® . <br /> Hardpan Q Adobe 0 Fill Material ............If yes,type.............. .......... <br /> (Plot plan, showing size of lat,.location of system in relation to wells, buildings, etc, must be placed an reverse side_) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) , Y <br /> ..........�! S�X .._ Liquid Depth ....?............. <br /> PACKAGE TREATMENT [ SEPTIC TANK�ci' ize• _ "' <br /> 1 .. Material�42:c`_...... No. Compartments .._..--•--.......... <br /> Capacity 1A!��--•- Type'��._ J ,.o- r <br /> Distance to nearest: Well ._/4 .r�................... <br /> Foundation..t. � -____-.__ Prop. Una ...�..42-_--....� <br /> Length of each line...,/ . .........__ Total Length , .... ... <br /> .EACHING LINE �` No. of Lines ...._.. ..... /,� / // <br /> 'D' sox ............ Typo-Filter Material r`� IRVC&Depth Filter Material . .,r ..........� ,.... .If � <br /> Distance to nearest= Weil .,��.�d-••.•-•-• Foundation .+ . .... _Prope�iy _Line .............. <br /> ar, )f +��!&' .. Number Filled <br /> SEEPAGE PIT [ ) Depth ._ piamet ,�......�;-.- oak <br /> R Yes No <br /> -- Water Table 8)ePth ..,.... ......Rock Size . .. ...... y"`' 7 <br /> ,��! _-•• <br /> ___-___-Foundation Prop. tine ...• . ....•. <br /> Distance to nearest: Well . • ..1��• __��__ — <br /> REPAIR/ADDiTJON 1prev. Sanitation Permit# ............................................ Date ........ <br /> �:.....-M..•.-•.._ I <br /> f <br /> rept~ is Tank f Specify Requirements) ............................... <br /> ...�_.... ......... .. _..._-.................:........7 <br /> R uirements) <br /> i�•spasa! Fieia (Specify eq ...........................•.............._....................... <br /> ...- <br /> ..._ ...........I;.............................................4,...._.....-'.................................. . ........_............ <br /> .......•-. ......---- r <br /> (Draw existing and required addition on reverse si ) <br /> I hereby codify that 1 have prep this application and that the work will be :done In accordance with San Joaquin <br /> c <br /> County Ordinances, State taws, and Rules and i7egulations of the San Joaquin t`CW Health District.)don'ts owner or liken- <br /> sed agents signature certifies the following: <br /> } "I certify that in the performance of the work for which this permit is issued, i shat! not employ any person in such manner <br /> as to be o su ect to kms ompensatton Laws of California°' <br /> Owner <br /> By ................ ............... ... _ ......... <br /> 3itle ..... .. <br /> i (if other owns <br /> FOR DEPARTMENT USE ONLY <br /> ..,�• .�'.�.. .._._...................... DATE <br /> APPLICATION ACCEPTED 8 .. .. _DATE>................................. ..•... <br /> BUILDING PERMIT ISSUED .......................................... ?�`-�-'e`'• ............- <br /> ......g: . •..... <br /> ADDITIONALCOMMENTS ........................................................................... <br /> ..... Date .lc .:. ........ <br /> .. _ <br /> t . <br /> Final inspection by: . ... '` M. <br /> Eli 13 2L 148 v. SAN JOAOOIN L�ALTH' DISTRICT J $fj�! f'3M <br />