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21 20 01Him.I <br /> U <br /> APPLICATION FOR SANITATION PERMIT _ <br /> ........................................ (Complete in Triplicate) Permit No. .. <br /> This Permit Expires i Year Pram Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Health Distrid for a permit to construct and Install the work herein <br /> described.This application h de lin clo p11 nee with Countfyf Ordinnqnce�Nfo�. 549 and existing Rules and Regulations: <br /> ' JOB ADDRESSAOCATiON �' + l G.�f!L.' Cifatec.'..d; PfP-W?�.,.CENSUS TRACT <br /> Owner's Name .. 4 ......„............_... <br /> Pbon r......._... <br /> Address ,r'�/.!. -r t/ 7'rl�t/ ..............__._._. y_ „.City � �..... a { .... <br /> +r...... .......... <br /> Contractor's <br /> Nome . }� �� `y ....Licmnre <br /> Installation will serve, Residence©Apartment aus�We l0I OTrailer Court <br /> Motel Other. . +�y/Fr�cr+G. <br /> Number of living units:............ Number of bedroamvZt. <br /> rbagm Grinder ............ Lor Sire G S .... <br /> Water Svpplyr Public System and name. ..... .„...,,,�.».. ..� ._.- „_. „..»_.... ..Private•. <br /> Character of soil to a depth of 3 feetr Sand t] Sift❑ Clay [3 Peat 0 Sandy Loam (3 Clay Loam❑ <br /> Hardpan L) Adobe 0 F:II Material.... ....If yes,type.........„„„._. <br /> t IPlat plan, showing size of lot, location of system In relollon to wells, buildings, ate must be pieced on reverse side.) <br /> NEW INSTALLATION: INo septic tank or seepage pit permitted If public sewer Is ovailobla within 200 feat,) <br /> PACKAGE TREATMENT SEPTIC TANK /� /✓� / <br /> t' [7QO Size � „ ...„..... Liquid Depth„. <br /> Capacity 11 . TypaPctE_Lct�Material. No. Com s� <br /> ... Compartments a� - s< <br /> € Distance to nearest, Wel! .,,� f r <br /> t •�•-..........,,,_.Foundarionf�.�...._..,prep.Lista <br /> # LEACHING LINE No. of LinesLength cads Ilnr. <br /> �....- gt ��..'��� Total Length� <br /> 'iJ' Box Type Filter Material Depth Filter Materlal ~ Z <br /> Dissanco !a nearest, Well..�r Foundation 3-,::? ............. proper” Lfata r �� <br /> SEEPAGE PIT Depth .aZ,ate ...- Dlamatar .3�..__._l <br /> --�.— fQvmbsn _ ...s ..,,_..1 RO& Filled Yev X No [� <br /> Water Table Depth „.... � RoaSize .,. <br /> i Distance to nearest,Well „-,Foundation'Zaul.,... Prop. tine <br /> REPAI1T/ADDITION(Frev.Sanitation Pennit#........... <br /> „._..„. ..».. ...-.-.... Data <br /> Septic Tank (Speclfv Requirements) ...........„..._-..„.. <br /> Disposal Field [Specify Requirements} ...................„_. ..» . _....._....» ... .. .„�. ..:r <br /> .....~.N-. .„..-.....� .»......._ (Draw existing and required addiNen on reverse,side) _._.. .„.„ - .„..-........ - <br /> y1;,s 1 hereby Certify that i have prepared this application and that the work will bo, in accordance with San Joaquin <br /> County Ordinances, State Lows, and Rules and Regulations of the San Joaquin Local Htisiih District.Bente owner or llcem- <br /> cad agents signature coMfies the fellawin9: <br /> "8 castffy that in the Pedero++ancs of the work far whish this Permit is Issued,I shall not ornpley any person In such mennef <br /> baca sub(ect 1P th,l's Cemt�on� on rows of California.” <br /> Signed... ....!. <br /> - -- I ----BY............:......:.:.:::.. r _ .._. ....„T l <br /> � Owner <br /> (if other henR.;4r it e ..................... ................. <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ <br /> BUILDING PERMIT ISSUED... .�... . .».. .... _.. . <br /> .r.._._........ ..................... DATE :. �Q..,...„... ......... <br /> `` <br /> c ADI7tT10NAL COMMENTS....................»»..._.»»._„_. .... .... ..._......„..._.......�.... .DATE: .......� .-„... <br /> � Finahlnspeetion by,�........ .7..„ _��.M...„...„'...._ ..»..»........................_..... <br /> ...„:.._..-.. A7=7 y..»..........._ .... <br /> »......._..... ._.. ............................ ......„�.=.L.rr.... .. <br /> » . <br /> 1. <br /> SAN JOACUIN LOCAL HEALTH DISTRICT <br />