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• FOR OFFICE USE: ' FOR OFFICE USE: <br /> l� APPLICATION FOR SANITATION PERMIT p n <br /> ! (Complete in Triplicate) Permit No.%/.' q <br /> Date Issued <br /> .•... This Permit Expires 1 Year From Dote Issued <br /> Application is hereby made to the Sun Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .>7 C'! I r_ -- T ... CENSUS TRACT ...... <br /> Owner's Name ..... Phone`/66-.e.79-P. <br /> Address City .t . . Zip,Q�'LS�O. . <br /> Contractor's Name . License #�` -.3y3 Phone w°��"�� . ...... <br /> Installation will serve. Residence [j Apartment House Commercial Trailer Court <br /> Motel 17 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 u depth of 3 feet: Sand F3 Silt❑ Clay F-J Peat I-] Sandy loam ❑ Clay loam <br /> Hardpan ❑ Adobebid Fill Motk•rial 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 /> 1 NEW INSTALLATION: (No septic tusk or seepage pit permitted if public sewer is available within 200 feet,)Flretv <br /> PACKAGE TREATMENT ( ► SEPTIC TANK ( J D Size 7 l/�� liquid Depth .. <br /> GEE SE THIP P Capacity 9VO Type I'•� Material t li. ..No. Compartments ....�... . <br /> Distant- to nearest: Well Foundation ../0 Prop. Line Ilk, <br /> i40 <br /> LEACHING LINE OQ No. of lines Length of each hne Total Length <br /> D' Box 60"' Type Filter Material 4%.4— Depth Filter Material - <br /> Dfslunee lu nearest: Weil } Foundation . ./O.,t Property line <br /> SEEPAGE PIT pO Depth 7S f Diameter 3,3 rr Number _ 1 - Rock Filled YesT4 No C3 <br /> to, <br /> ht <br /> Water Table Depth Rock Size Y /& • <br /> Distance to nearest: Well /010 Foundation <br /> /d rt Prop. line• s <br /> REPAIR/ADDITION (Prev. Sanitation Permit # Date ) <br /> Septic Tank (Specify Requirements) <br /> Disposal i Feld (Specify Requirenfents( <br /> (Draw existing unci required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not a nploy any person in such manner of <br /> 3 to become subject to Workman's Compensation laws of California." <br /> Signed (/ 1 <br /> Owner <br /> By I r �1 Title <br /> Iff ler than c,vneri - - <br /> FOR DEPARTMENT USE ONLY <br /> --- DATE <br /> APPLICATION ACCEPTED BY 42! DATE <br /> D1VISiON Or LAt,D r:W)`.BEK ,r./ �' �'�S"►''^: <br /> ADDITIOtrAI CG�',4rE':1Sr•�' t� �`--���' - «��'�"J <br /> Date <br /> Final InsoeU,w) ;,y <br /> r <br /> rs5)yell �kV r.is 7re <br /> SAE: JOAQUIrt LOCAL tIEALTit DISTRICT <br /> r <br /> f <br />