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FOR OFFICE USE: - <br /> APPLICATION POR SANITATION PERMIT <br /> £ (Complete in Triplicate) Permit No: <br /> --------- This Permit Expires 1 Year From Date Issued 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 /> JOB ADDRESS/LOCATION -----A7_ Q --------- -----/I ----/i�e1.,1__1VCE US TRACT ---------------- <br /> Owner's Name ---- - L�J�/ �ri1 �,.i9eeL_P_ .1 ---------------------------Phone ------------------- <br /> Address .... 7'��.e / rC-y------------- P� <br /> --- City - ���? ------------------------------ <br /> Contractor's Name _.License #pC&:�f.1-7 --- Phone <br /> Installation will serve: iResidence [k'Apartment House❑ Commercial❑Trailer Court ❑ <br /> Motel ❑Other <br /> Number of living units:-----/ Number of bedrooms -_ -----_Garbage Grinders- "_ Lot Size -_ 5'�, _ ____ � <br /> ---------------------- <br /> Water Supply: Public System and name ------Io �_____1W._ -___�-_-___----------------------------------------------------------Private ` ^ <br /> Character of soil to a depth of 3 feet: Sand'w Sift.❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> G Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, <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 a EPT TANK [ Size_-, -.' -__-_}�/(l- ---------------- Liquid Depth --%S--------------------- <br /> Cac <br /> p y/- _ ai"-__ Type A_4<4m!�_ Material___( _. --- . No.. Compartments - ---------------- <br /> Distance to nearest: Well __,5 -----__---------------------Foundation _/1 -------------- Prop. Line -----6---- <br /> LEACHING LINE No. of Lines ---w?--- __ _________ length of each line------ __-----__ Total Length ------------ <br /> i- - <br /> 'D' Box _/----- Type Filter Material A ---__Depth Filter Material ---/.1 r_� <br /> 'Distance to nearest: Well -. ---------- Foundation ---- . Property Line _1. ___._------ <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number „-- __-_--- Rock Filled Yes ❑ No ❑ <br /> - ----------------- <br /> Water Table DepthA------------------------------------------------Rock Size ------------------ ------------- <br /> Distance to nearest: Well ----------------------------------------Foundation r.................... Prop. Line ------------------ <br /> REPAIR/ADDITION(Prev. <br /> ---.---.-----.-.REPAIRJADDITION(Prev. Sanitation Permit# --------- ----------------------------------- Date ------------------------------------ <br /> Septic <br /> __-- -Septic Tank (Specify Requirements) --------------------------------------------------------------------------------- <br /> Disposal Field (Specify Requirements) -_---_----------------------- <br /> Y' _ ____,�-' -"--=--- -- _ -•-=---- __ ------------------------------------ _-- - <br /> idx <br /> (Draw existing and required addition on reverse se) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven. <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." ff <br /> Signed --- ---- ----------------- -------------- _ Owner 4 <br /> BY --- - --------------- -------------------------------------------------------------------------------- Title -------- ----------, --------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -: --__-_-- _-- -- -- ------------- DATE -----------------------�-- -- <br /> ---------------------------------------------------------------BUILDING PERMIT ISSUED --------------------------- -----------DATE ------------ ------------------------------- <br /> ADDITIONAL <br /> COMMENTS ----------------------------------------------- <br /> ------- ------------------- <br /> ..- ---:- _,_ex. •.,,-- - ------------------------------------------- <br /> ------ - <br /> - ------ ' <br /> ------- ------------------------------- ----- ---------- ---- ----------------------------'--..-__________-_- ---_-_-_-_--------------------_-----_ <br /> --------------------------'''-__ - - - <br /> -- - ---------------------- --- --------- ----- ---- --Date --- - �'-- -1 - •Final Inspection by: r --- - --- -- -------------------------------------------------- <br /> SAN <br /> --- ------- ----------- <br /> SAN <br /> F <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> k <br /> E. H. 9 1-'bi3 Rev. 5M. i <br />