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FOR OFFICE USE:
<br /> APPLICATION FOR SANITATION PERMIT
<br /> ............................ .,. .b....-...... Permit No.
<br /> (Complete in Triplicate) i
<br /> i
<br /> Date Issued .47.:?:.�••�.
<br /> ......... This Permit Expires 3 Year From bats 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 ADDRESSJLOCATiON .....3539. ?bek L??± �...............:..- ...............................CENSUS TRACT ..........................
<br /> Owner's Name N, rnancj. ... t,. ................................................. ..........»....................Phone ........... "b 3...
<br /> Address ...sat1e......................` ....., _.......................»..................City ....................,Stk'.1^,.................___......................
<br /> Contractor's Name '
<br /> ........__..�. ..........License # 26$. 1..... Phonsikb . •03........
<br /> t
<br /> installation will serve: Residence[3Aportment ousel &mmerciol QTroll{er Court 0 }
<br /> Motel ❑Other.............. ... `"-::._..
<br /> r t
<br /> Number of living units:1.........._ Number of bedrooms ....3......Garbage Grinder ............ ot,Size ..27,�sJ-...acxos=; •••••••.....•
<br /> Water Supply Public System and name ................ .....................................121
<br /> acrocter of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Pept© Sandy Loam 0 Clay Loa.6
<br /> Hardpan ❑ Adobe Q Fill Material ............if yes,type ........ ................. i LWT
<br /> (Plat plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) 1
<br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ctvallable within 200 feet,)
<br /> PACKAGE TREATMENT SEPTIC TANK'( ) Size........................ ................. Liquid Depth _.f........................
<br /> ,( Capacity .................... Type .................... Material...................... No. Compartments .....
<br /> i Distance to nearest: Well ....................................Foundation ....................-- Prop. Line ...................
<br /> CACHING LINE [_7j No. of Cines .... .._......1__... , Length of each line.......#3(}.*.............. Total Length _... ............
<br /> 'D' Box ..1....... Type Filter Material .........Zn__-.--Oepth Filter Material ........-l.9........... ..
<br /> Distance to nearest: Well .__.. �d.Q .- --..__ Foundation 50 Y................. Property Line _50-t...............
<br /> SSEE - r
<br /> EPAGE PIT } Depth-,._2j.!.:-.. Diameter_.......__...:13 Vumbe:•. -.._::::: .�__.._....... Rock Filled Yea �j No Q
<br /> Water Table Depth 90.t...........................Rock Size ,'....2:'..,....._....._..._.. i
<br /> I Prop. Line ........
<br /> Distance to nearest: Wein-:\.......1Qfl.'........... .......Foundation ... }...._.,..,.: _ ..
<br /> REPAIR D1Ti (Prev. Sanitation Permit alt ..... .... ............................. Date .... ............
<br /> }
<br /> Tank (Specify'.Requirements) r) �r�- -- .-•__ r . .-..• t................:
<br /> } r
<br /> j
<br /> 10isposor Field (Specify Requirements) ...........$C}•_-.•L� 'l1•-L e .1 ... ..Li ��„ �. e:..:..�it� �................. !
<br /> . ............................... ' .._...__.....................4. .............,_,.._... ........ ......... ...._... ( ...................................».......................
<br /> `�t I .. ... ..............................x..,....._........,. .
<br /> -.,�............................•--.i....................... .................... �.•.....,............ . .. _.....
<br /> (Draw existing and required addition on reverse side) I r
<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, StcfaLaws, and�Rules and'Rig—.1511W.'of the San Joaquin Cowl Health District. Herne,owner or lie*".
<br /> sod agents signature certifies the following: l r:
<br /> "I'certify that in tiro performance of the work for which this permit is issued, 1 ,69011 not employ any persoe in such manner
<br /> t
<br /> as'to become subject to Workman's Compensation laws of California."
<br /> Signed .......... ......................... _._..__. Owner
<br /> ....._.
<br /> By . ......c �l
<br /> Contractor................... i
<br /> (If other than owned
<br /> FOR DEPARTAAENT USIE.ONLY l
<br /> APPLICATION ACCEPTED BY. . .... . . ................... ...................... ..............• DATE _. ........,...
<br /> BOILDING PERMIT ISSUED ......... ;.1; ............................... ...............DATE ........_........._........................ �
<br /> �DI7iONAL COMMENTS......... . ••••-•.......�....................... .....,..... ............................ .......................................---
<br /> +. ............................................................,..,......,....,......,.,...... .. ............._................................-....._..._......... ..._,.....---•µ.... ,. !
<br /> Finalinspection by: ......�,1`. ...................... !. ..-.._........ .........,.,..,...»».........Date ..._.�J:�l:.fl�� ...._...._._�
<br /> I �`i
<br /> t _ .•*., 56NJOAQUIN LCJCAL HEALTH DISTRICT
<br /> .> 1 I 9G 7179 3 M
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