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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ' __.--------- <br /> ......--`------..... <br /> --------- <br /> --- Permit No: <br /> (Complete in Triplicate) <br /> --- <br /> ---------------------------------- P <br /> - <br /> Date Issued 1 ..z�-.. ." <br /> This Permit Expires 1 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 with County Ordinance No. 549 and existing Rules and Regulations: <br /> 2 No of Durham ep p <br /> JOB ADDRESS/LOCATION ......" .143j D3Ater"_R4.aCL�---`F.r&O}L-......... ...."--- _..........CENS T --------------..."_... <br /> Owner's Name ----._Qflr.IiOl1..gOt.'h.3d""..".---------................__".-....------------............_--------------Phone._.....----------.......---------- <br /> �. <br /> Address -- -2 673.----S'.--GN�r.Ssman Hd -.............------.City ..-T.rae"}r:.... .......................... - -..... . <br /> Contractor's Name .... lm_cjy�5' "-"P. .tbAlblLlg""$.2S.Y1G@..._-:"""_..License # ."".-9�-2�...:.. Phone M77311.4"-"-""-_ <br /> ' installation will serve: Residence]XApartment House❑ Commercial{]Trailer Court !❑ <br /> Motel ❑Other............ ........."..........-------- <br /> Number of living units:....1:"__ Number of bedrooms .."""""..3Garbage Grinder ...."".".... Lot Size .....AC-el"aga................... <br /> Water Supply: Public System and name ----------------."................................ ---.-:---r--':.....-c-......... :----:----------Private$T <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat 0 f Sandy Loam 0 Clay Loam j] <br /> tHardpan E] Adobe o Fill Material'."".......•If yes,type....,".". <br /> {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is aj' able within 200'feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK fZ. - _ <br /> Size"""1���1�f K X9�- ~..-"-".... Liquid Depth .. 4"6n.:....... <br /> Capacity 1200"",""---- TypePX_0'-b'&3t Material...Cone.PBteNo. Compartments .....a.............. <br /> ' Distance to nearest: Well _25.+"__----------------"----Foundation _I"..."10.-...... Prop. Line .....Jr"Q).;: "..... <br /> LEACHING LINE [X No. of Lines _ ----3.-----------... Length of each Total Length ".__2Z!Ot <br /> .-------....".. <br /> 'D' Box "...j.... Type Filter Material $e Pt----RkDepth Filtef Material "."".1 �---------------""-""-"_.._` <br /> 1 <br /> :w - t <br /> Distance�To�nearest:-Well .851----—.-:""" Foundation ."" � .� P�'. �O-.•--•=•--" <br /> -�-- - - � 3.Jr ,.�,-,..----- Pro e. Line --'-�----- <br /> SEEPAGE PIT Depth .-.--- Diameter ............... Number ......-------- ..".."""... Rock Filled Yes ❑ No 0 <br /> ' Water Table Depth ._.----......:... ------------Rock Size j."............. ------------ <br /> Distance to nearest: Well ...... ......... .........."".""...Foundation .__...""_."."."_ Prop. Line ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# "------- ............---------".. ... Date ....."""..e.................""....1 t `' <br /> : <br /> ' Septic Tank (Specify Requirements) ---------------------_--- <br /> Disposal Field (Specify Requirements)/:-e---------------......._................------------........�.....__..----------- ----------........-- <br /> ...-----�. <br /> __..-----------t-.....--F------------...-- <br /> ..........----------------------------------------.......`-.i............----------........-.--------------------;............. -------------- r <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquinl <br /> " County Ordinances, State Laws, and Rules and Regulations of the.Ian Joaquin Loccl Health District.�'Hpme owner or licen. <br /> sed agents signature certifies the following: 1,_., I �. ' I I <br /> "I certify that in the performance of the-work for which this permit is issued, I shall not employ any person lo'suchlmanner <br /> as to become subject to Workman's Compensation ws of Calif rnia." <br /> Signed "_PALMQUIST""PLUZ✓iB.ING"..$E [ " .". <br /> By__---- ._-'--------------------------- ---- --- Title .....MaASge2!..-.... --------------.._.------- <br /> (If other than owner) <br /> ' FOR DE RT NT US O. <br /> ." :pc/ - <br /> APPLICATION ACCEPTED BY--------�--`..............- ------ DATEI� �- _------------- <br /> ------------... -- -- ---- <br /> BUILDING PERMIT ISSUED.................. :.r...:...r.....:.}:":":..-.:. ---------- -....,-- ....DATE <br /> ADDITIONAL COMMENTS- - - ------------.............. ---- _. . ----------------- .-- -- <br /> ---------- <br /> -------- ---- `....--: -----, ................. - .....�¢�1s2 ... &....,..z-`a r ro;.. .. - -- .. . ........"..." <br /> ..................................I-------------- -------------------- --....."".........------ ...... ...... <br /> - ... ------------------------------.:.- ... .."................... --....................�AL <br /> ---- <br /> Final inspection by: -------------------- -------------.IN- LOCA <br /> ....._ -----. .r . -------......... <br /> ' SAN JOAQUIN LOCAL HT DISTRi <br />