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APPLICATION FOR SANITATION PERMIT
<br /> ....................................................... Permit No7.
<br /> (Complete In Triplicate) • ... ..
<br /> This rennit Expiresit YiEar from Datelswed Dab issued
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<br /> Application Is hereby made to the SarfJoaquln Local Health District fora permit to construct and Install .the work herein ,
<br /> described, This application is made In compliancewith-County Ordlna ce No. 549 on existing Rules and Regulatlonu
<br /> JOB ADDRESS/LOCATI�IV , ..:;`�..�sQ...... ' ....:..........�.. ..�.: . ....�. ...„.
<br /> ••„ � .... .•• •.•..,:•.,;,-. -• ...J f.r t ..CFNSVS TRACT .r..a•I.....Ii11.••jY:,
<br /> Owner's Name ... : �...... ... ' ............ Phone f Phone .........:..............
<br /> Address •
<br /> r � z'�.�.:..... : -.. . ....._Cls,,,: ?:::
<br /> N
<br /> Contractor'
<br /> .. : (cense
<br /> odor: idame:,��. ...:.•.��t.. , ...�.��� �`�'�:� ..�..�� / -•
<br /> . Inxtallation will serve, lteNdence 0 A"ent House❑ Commercial❑Trailer Court 0
<br /> JT
<br /> AAorol p Other.............................................
<br /> Number of living unit::. .... Number �
<br /> 0 � .�..... *go.Grinder .•.:�:::. Lot Six .. .��... :!�...� ....... y'
<br /> Water Supply, Public System and name .Q .�? .�.�... ..:.. ' �` - •---.... •. •+
<br /> Character of soil to a depth of 3 feet, Sand❑ Silt[� Clay ❑ .Peat ~..San-...................
<br /> .Loam.• d M . �'vats
<br /> ® Sandy ® Clay
<br /> Hardpan❑ Adobe FIII Material ............ if yes,type.......... ............
<br /> (Plot plan, showing;size of lot, location of system in relation to wells, buildings, etc. must be placod on reverse side
<br /> NEW INSTALLATION' (No see tank or seepage pit permitted If public sewer Is oyalloble within 21x4 feet,) :T
<br /> PACKAGE TREATMENT. { ] SiC TANK. Sire... ' + ......., LiquidDepth., D
<br /> r ! Capacity? Qi r ...... Tyne �I.�' ,,;rrP
<br /> ..-terial.`.: ...��� ... ... . No. Compartments a ......M
<br /> Distance to nears to Wel .. .Foundation. .�. ... Prop. Line..
<br /> LEACHING LINE . No. of lines .... .............. Length Lof dt ,ll e....:,' �........:. Total L th .. ..tet"`... --
<br /> . »».
<br /> Box ..:/.......Type Filter Material . ... , .Depth Filter Material :j � ........
<br /> 10 Distance to nearost, Well !':'. : Foundation .. Q . ...... Pr Line •. ,,, .
<br /> . .....
<br /> ... ape
<br /> SEEPAGE, PIT Depth . ..... Dia ter . . �f Number ? �
<br /> . . .. Rack Filled Ye
<br /> Water Table Depth .... ...... .........Rock Size .. .. . .:. .............
<br /> Distance to nearest, Well .f:^�... ...........:.Foundation. .. �:r...... Prop: Litre ......
<br /> REPAIR/ADDITION(Prev. Sanitation Permit¢ .......,.........:.......................... Date .................:,.,•.a.:...::..5'} .
<br /> ... Septic Tank (Specify Requirements) .............. ..:......• :::...:......:............. ..........
<br /> :.
<br /> Disposal. Field ,(Specify' Requirements) .......................................................................................................................................
<br /> ..` ....................................... .. ... ....
<br /> .......... .... .. .................. and re vi---d addlti....- •-----•.:......:. ... ...._....................
<br /> (Draw .,........,.. .......... , t
<br />` g q re an on reverse aide).... . �.
<br /> I hereby certify that,I have prepared this application and that the work will be done In accordance with Sar JoagVIN ” .
<br /> County Ordinances,'.Stale Laws, and Rules and Regulations of the Son Joaquin Local Health District. Herne owner or neem
<br /> sed agents signature certifies the followings
<br /> "I certify that In the performance of the work for which this ermit is Issued I shall not employ 11-
<br />.` h , p y an� pen0lt In s'l'at,illalMer.•1.:
<br /> as to become subject to Workman's Compensation laws of California."
<br /> Signed ........................................ ................................ Owner
<br /> tr > By ....... L. : ....:.... . t ...r.......:: . d:� 3�
<br /> . 'dlf other than �owner)........ _ ...........�. �tle . ..........................
<br /> ."'t DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY ...
<br /> G: BUILDING PERMIT ISSUED ........ .................................. . . DATE DATE .. �..... .r.............:....
<br /> ADDITIONAL COMMENTS ..... :: ' .DATE.
<br /> y ...................................... ...�• ... ,. ....••.......••......•..r.....................................................
<br /> •••.•••....••••'..............................• r '........ ........... ...•.........•..•............,....9
<br /> Final tnspectian bY� . .. ......■`�.... . ......
<br /> •.. + .......•...i•,•....•..• ....•...• Oate
<br /> JOAQUIN LOCAL HEALTH DISTRICT ��7}t
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