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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------------------------- !� ` Permit No. <br /> e) '6 <br /> (Complete In Triplicate) <br /> ..... --- ` <br /> .............................. ,. .. �.- -.._. .� ,. .. . _ r_ _._ . ... -._.�.._.. sued /.3.::.17r� <br /> This permit Expires t Year from Date issued <br /> Date is <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construd.and install the work herein <br /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> / `1/ IIVf�1N.,GtTR.... c�..-...�.1,.4..c .............CENSUS TRACT .................... <br /> .tOi9 ADDRESS LOC�vATION ..�.t�.-� �g... r.•. . ...... <br /> iOwner's Name ..L�. ................. ................................................Phone ...'�.`3 ". �.�' <br /> Address-5-4.99 .. .............................City ,.4t ............................ <br /> Contractor's Name........ ....................................................License# ........................ Phone ........-:7 .................. <br /> Installation will serve: ResidenceX Apartment House(] Commercial QTrailer Court 0 <br /> 1 <br /> Motel Q Other............................................ <br /> Number of living units:.......... Number of bedrooms ....%&....Garbage Grinder ............ Lot Size 4.4.2.,ff+ -j9 e................... <br /> Water Supply: Public System and name 1..1.........................:..:.:....................:..Prlvate� <br /> Character of soil to a depth of 3 feet: Sand Q. Silt Q Clay Q Peat❑ Sandy Loam Clay Loam❑ <br /> Hardpan p Adobe 0 _Fill Material <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 81419.1 <br /> NEW INSTALLATION; INo septic tank or seepage pit.permitted if public sewer is avoilable within 200 feet) <br /> PACKAGE TREATMENT .[.] SEPTIC TANK{ Size_4. '._ 'ji...--..�' '(?... Lkquld"Depth'....�F:.li�... <br /> .......- <br /> i. 0.4-4 ..,...:.. <br /> Capacityfl,9dQ_9F_�-/ Type Sh4i''ilnKsMaterial '�ty.e. No. Compartments .::-- . <br /> 1 N <br /> Distance,to nearest: Well .... �?.... .Foundation ...d.d Prop. Line . asp`............... <br /> ' LEACHING LINE [ j No. of Lines •._•. ............... Length of each fine._- gip.:.......... Total Length ......i-V-a.`........•• <br /> 1 " <br /> 'D' Box 2.. .... Type Filter Material Depth .Filter Material ....11..V..................... <br /> Distance to nearest: Well ...A4.4:7.......... Foundation .....�-lilt'. Property Line ... <br /> SEEPAGE PIT ( } Depth ....IP._�........ f} eter.. ........ .... Number :._....,f.....--........._.. Rock Filled Yes No Qn <br /> %1-1 .Rock Size �' <br /> - Water Table Depth -��...........................�._......... ................................... <br /> l <br /> Distance to nearest: Well ....... :-f!........•...._._•_....._foundation ..ff.A!....... Prop. line ....c? ......:.•.... <br /> # REPAIR/ADDITION{Prev. Sanitation Permit# .........=... ........ Date -I <br /> Septic Tank lS if <br /> ..........••-•--•-----•...............•----------.................•--.......--•....................-- <br /> Y Re uirementsl. <br /> Disposal .Field (Specify Requirements) ---------•----•-•...................................... ......................................................................... <br /> ... <br /> ............................................................................................_.................................... ...................................................... <br /> ( <br /> ............................................................................................................-.............................. ....................-..................... .................. <br /> _ {Draw existing and required addition on reverse stilet " = - <br /> I hereby certify that I have prepared this application and that the work will be done in acierdance with San Joaquin <br /> County Ordinances, State Laws,-and Rules and Regulations of the San Joaquin Local Health.Distrld. Home Owner Or. Iltert- <br /> sed agents signature certifies the following: <br /> "I 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 becom let to Work 's Compensation laws of Calil'arnla." <br /> l Signed . Owner <br /> l // ---- Title _. .. ....... . ...... <br /> BY '................................... <br /> (If other than owner) i <br /> FOR;DEPARTMENT USE.ONLY <br /> APPLICATION ACCEPTED BY - C° '--•------------•--•-•-•-- .............................. -- ©ATE._./ :�: .�2..--..7 ...,..:.: <br /> BUILDING PERMIT"ISSUED ---------- ------------ ...:............-•---.............................•......................DA .......................................... <br /> . <br /> ADDITIONAL COMMENTS .................--.........................I....................._..... <br /> ---------- ---•--- --.................----- ` �_ ...... ------........ ...'................ ._... ................................ .... <br /> final Inspection by: ................... ....... ��- ..---............ <br /> EH 13 24 1-6(1 iiev. 5M L/ SA JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />