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*` FOR C)FFICE USEe
<br /> APPLICAPON FOP SANITATION PERM?,
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<br /> .._ ................. (Cornplafa in Triplicates tvarmlt No. ..r.i�
<br /> ......... This Pe it DatQfssu6d . Oaie Issued . .�.:�,.�......�
<br /> rmit Expires 1 Year Fr ro
<br /> Applicotiorl.is hereby made to the San Joaquin Local Health District for upermit to construct and Install the work herelln
<br /> P described. This application le made In compliance with County Ordinance M. 549 and existing Rules and Regulationai
<br /> JOB ADDRESS/LOCATION ��c�.� �. ...N.. ..,,� _ .�t'11,�....................1.,_.__......GI:NSU5 TRACT ,............I.....,,w..,
<br /> `Owner't Name ,. .., �,r/ e ,�*t�� / .................. . .... . a. ......, ..phone,? � /`� .......
<br /> Address .... , .......................... . ......,.....................,.::City ...........,..:... ..........., ... ..........,.............
<br /> Contractor's Name Phone ��; al.
<br /> Installation will-so
<br /> fve� Y Residence;AparfmAn:fi•iCtuse.��Cammerclal;�jTr.alier.,Court,f]
<br /> Motel [1 Other ............................................
<br /> ,,. Dumber of living Number of bedrooms .,, '..,....Garbage Grinder ......... at 5ixb
<br /> Water Supply;.l?ubllccystem and name ..._................................................,.._. ............................ .. ............,.,.Prlvpte�
<br /> j Character of soil to a depth of 3 feeh Sandji5 .Slit p Clay ll 'Pegt Sandy Loam C1 Clay Loam Q
<br /> Hardpan Q Adobe Q Pill Mi terlal ............If yes,typo .......................
<br /> (Plot plan, showing size of lot, location of- aystem In relation to wells, buildings, eft, muot be placed on reverse side,)
<br /> NEW INSTALi~A710Ni —(No septic tank or seepage pit permitted if publlc sewer Is ovallable within 200 feet,) a
<br /> r r •. .17�...--..... Liquid Depth .. ...............
<br /> PACKAGE TREATMi:N� � 7 SEPTIC TANiC;� � Slge...�"F,,.�.s:.�-.�.. ... q P ••••�
<br /> ,Capacity AD. . Type ,�+"�'�Materla '1� No. Compartments
<br /> Distance to nearest, Well .. . .., ..r....�..... , .Foundation ., ,........... Prop, tine . ..........
<br /> r
<br /> LEACHING LINE No. of linea !. ............... Length of each II Mo.. a................ Total length .. .__ ...-.........k
<br /> •. 'D' Box / : Type Filter Material .../&e1L..Depth I'llter Material .../47.r•............... ......... .
<br /> Dlstdncs to ne'arest. Well ... �........... Feundotion ./or............... Property Line ... ....................
<br /> SEEPAGE PIT ( i Depth Dinmefer ................ Number .................,..,....... Rock Filled Yes [3 No Q
<br /> Wafer Table Depth ............., 1 ..........._ .......Rock Size .................................
<br /> Distance to nearest, Well.............. . . . ............_.Fovndotlon ........... Prop..IJne ............ . .....
<br /> 1
<br /> REPAIR/ADDITION(Prey, Sanitotlon Permit 0 .... . .......................... •• Dole ,. ..............................)
<br /> Septic Tank (Specify RequirOMOnts) ............................................�. .......................... .._ ........... ......,.......,......
<br /> Disposal Field (Specify Requirements) .......... .. . ............... .... ........I.................. ._ .,............ ... .......,.............._...-,............
<br /> ..............................................,................................................. .•.;................. 1 . . --............, .............,....................
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<br /> ......................................:... ... ................ .,....... .. ....... ...-- ...._ ........................ ... .. ........ . . . ............
<br /> (Draw existing and requiredladdiytion on reverse side)
<br /> — ared this application and that thework will be dono-in accordantu wlth•San Joaquin
<br /> I hereby certify that I have prep
<br /> County Ordinances, State lows,'and Rules and Regulations of Iho San'Jdaquin focal Health District, lfom• owner or Iic"r
<br /> I ted agents signature certlfles the following. ,..-•,�,..> �.. ,_,,;.w, .: -. �._ .�..o, - -
<br /> "I cerllfy that in the performance of the work for which Ibis permit Is Issued, 1 Doll not employ any person In ouch mannw
<br /> as to become cublect to Workman's.Compensation laws of Callfarnlo."
<br /> Signed............ ...............ean_ow• ....,............,. Qwner
<br /> By , :... .... .................... .itis .' � 1:...� :...."...._... . ..,
<br /> ! (If other t
<br /> FOR DEPARTMENT IJS0 ONLY
<br /> APPLICATION ACCEPTED BY.. DATE ... ..: .....:...
<br /> BUILDINGPERMIT ISSUED __..............,.1... r ....t...................... .... ................... ........... ,...DATE .............. ,_�:.....
<br /> ADDITIONALCOMMENTS ........... ...................................................... .........................., ...... ....,...............1 .........
<br /> ::......... .. ....... :. ..... .. ,,..... :.., ........
<br /> ...,................
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<br /> FInGI Inspection by; ......rreY" F' .........,1 , .... - ...Dote ,..., ...
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