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r.. r <br /> FOR OFFICc- USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> .:o;rtplete in Triplicate) <br /> Permit No. . 3-.5X-7.... <br /> This Per n:. Expires 1 Year From Date Issued Date Issued .... <br /> Application is hereby mode to the San Joaquin lo, .4ealth District for a permit to construct and install the work hereir <br /> described. This application is made in compliance w th County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATiON �G:�,j `f-`�• %�. .. .. ..... .. .... CENSUS TRACT .................... <br /> Owner's Nome C 1IL/ Y <br /> 1�t_�?,J....... ;...-... . . .. ................Phone ...............................�. <br /> Addn+ss C��� �J. -^� " 2- city /.��� ....................... .1 Lc,r [.. .. .1�G ...LC... .....-. .. ...z.� <br /> Contractor's Name S .license ��c� y.. Phone ..........................._. <br /> C.��t�t�G�....'t ac... .....- �..... .... .. <br /> Installation will serve: Residence Apartment House Q Commercial ❑Trailer Court <br /> Motel C]Other .........� .............. <br /> Number of living units: Number of bedrooms ............Garbage Grinder ............ lot Size ............................. ......... <br /> Water Supply: Public System and name ................ ......._...................................................Private ' <br /> Character of soil to a depth of 3 feet: SandSilt L7 Cloy ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan Adobe ❑ 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 available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK liquid Depth 'V-................... T <br /> Copacity3�c'lf;I��Type _�ti:.•�. Material..�G�^d_... No. Compartments ....-5.............. <br /> i Distance to near e� <br /> Well ...........Found ... PropC. line.-.ation ......La <br /> LEACHING LINE ('1 No. of Lines ,� . . .. length of each line 16e.,[,T:_. Total Length <br /> 'D' Box Type Filter Material .......S..P,....Depth Filtdrt Material Ut <br /> Distance to nearest: Well Foundationt'O. PropLine ..5�.......... <br /> SEEPAGE PIT �{ Depth Diameter .VY ....... Numbe- � �. erty Rock Filled Yes �No C"j <br /> Water Table Deeth .. .................Rock Size .. :3..--.--- <br /> Distance to nearest: Well �/. L./. ... .foundation . /L. ... Prop. line .... <br /> REPAIVADDITiON(Prev. Sanitation Permit# .... .. ... . . .... ......_ ........ Date ..................................) <br /> Septic Tank (Specify Requirements) __... .. ... ...... ..... . ....... .......... .............................. <br /> -, <br /> Disposal Field (Specify Requirements) ..... . .... ..... _ .... . .._.._.............................. <br /> _ . . . .. . . . ... ........ . _ ...... ....................... <br /> (Draw existirg 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 Ordinance+, State laws, and Rubs and Regulations of the Son Joaquin Local Health District. Home owner or lic+n- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such rnamser <br /> as to become subject to Work'n"'t Compensation laws of California." <br /> Signed ,s _ Owner•� <br /> By - Crl(✓��< LZ (� � . Title <br /> Ili other the owner) �- <br /> .<<; <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE�� - �� •-• • - <br /> BUILDiNG PERM17 ISSUED 1 DATE ... ... •--. <br /> ADDITIONAL COra'11ENTS • ...... ........ <br /> Vn3l Inspta on by. `- <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> .7 M <br />