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FOR OFFICE USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No 1 r = a <br /> (COP pisM In Triplicate) <br /> Dara tuned '3 <br /> This permit Expires I Year,From Deb Issued a <br /> 1 ................... .._. ... KSr <br /> Application is hereby mode.to the San Joaquin local Health District for a permit to con rruct and Install }Fb,work h'nN� ^z <br /> ;i Jr ,desalted. This application la mode in compliance with,County Ordinance <br /> l �,N�o�. 5A9 and rxi R nd RsguloHbny' r r <br /> FtCri a� CENSUS TRACT <br /> JOB ADDRESS/LOC\LtL;N <br /> OWYI j .. <br /> ...17 ,CJ .... Phone <br /> n � ner'a.Name (y✓ .. ... <br /> Address ..-Z.. '.. ... .... J.j:...... :.. ......... City .. .. <br /> �r=> t C .Ll ense # .1 a 3Q..y phone <br /> ControctorsName . { i <br /> .. - ... t ;$a� r.,Y f .yrv, <br /> ..- . ..'.'Prig ,.. <br /> Inatalloteon Will serve - Residence CD <br /> House❑ Commercial❑Troller r certa„r ,Ise ;c'., <br /> .Motel Other .. .. .... ... <br /> oomsGarbage Grinder yy. <br /> p .. ..r... :. <br /> Number of living units:.. I ... Number of bedrLt_:ae <br /> . .water Supply Public System and name --..- ..' . ...•. . "' ....." ---- - 3 <br /> r Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay El Peat Peat❑ Sandy Lm ❑ Clay Loam[j.', <br /> , <br /> s. <br /> Hardpan. ,Adobe ❑ FIII Material . If/es,'YP*f - <br /> z �' IPIO1 plan, showing size of lot, lomtlon of system In relation to walla, buildings; eft: :rust.be oltlad;,on tdVMlfr, .". <br /> f NEW INSTALLATIONt INC septic tank or seepage pit permitted if public sewer H.aJaiU ole within 200 feH la <br /> 'PACKAGE TREATMENT . [ ] SEPTIC TANK f ]. Size- - ' -: . ._ Liquid Depth' <br /> Material. Compartments-4,...=- <br /> Capacity <br /> � <br /> .. . Typo � � r <br /> Distance to nearest Well Foundation rap. Line <br /> { " - Length of each line -. Total Length :: r <br /> f <br /> M. <br /> r LEACHING LIVE I I No. of Lines .. ... . 9 <br /> j. D' Box ...... Type Filter Material Depth Filter t:nterlal - <br /> "' w3 - Foundation . .- Proporty Li <br /> Distance to nearest. Wall .. ... - " <br /> Roc Filled .Yes ❑ ...No <br /> , <br /> 1 ,E SEEPAGE PIT [ ) Depth Diameter ... . Numbe . - <br /> f{j <br /> W ter Table Depth -------- .. _ ...Rock Size -- <br /> - Foundation Prop. Line . .... <br /> Distance to nearash Well ..... '- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date - - 1 <br /> ' Septic Tank (Specify Requirements) . - <br /> 1 <br /> ,( Disposal Field (Specify Requirements) ... <br /> (Draw existing and required addition on reverse side) <br /> �I hereby eertify that I have prepared this application and that the work will be dere in.accordance .with San Joaquin <br /> County Ordinances, Stab Laws, and Rules and Regulations of the Son Joaquin Local H,101-11 District- Herne Owner a I(ceo- <br /> 9 'sod agents signature certifies the following: <br /> ."I certify that In the perfonrance of the work for which this permit Is i•suad, 1 shall not ompley any person In such manner <br /> has to become sub)ect to Workman's Ce pensation laws of Ca Bfornla:' <br /> �Chvner <br /> . . Signed .... ._... �. .By <br /> so' / <br /> •aJ.. ../ ole , <br /> (If o$er thon owner) <br /> i FOR DEPARTMENT USE ONLY - <br /> ®® a� DATE <br /> APPLICATION ACCEPTED BY.i�i`„" .... ...... ..................... _ .. <br /> . ...DATE ....: ,. <br /> BUILDING PERMIT ISSUED - .. . . ...... _. <br /> ADDITIONAL COMMENTS - "' - <br /> _ ... .... . .... .. <br /> Date <br /> Final Inspection by:�G%�y�`J'yi`zr"'...... . .. ...... ..................- .._ <br /> - SAN JOACUIN LOCAL HEALTH DISTRICT <br /> I E. H. 9 1•'66 Rev. 5M <br /> �a�' b <br /> w¢te,, �. <br />