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rt4M3 <br /> FOR OFFICE USE: APPLIr"ATiON FOR SANITATION PERMIT <br /> Permit No. ...7-3 ' � <br /> ....................... (Complete in Triplicate) 3 <br /> .........I................ Date issued '. ...._.:. ' <br /> Yhis Permit Expires i Year From Date issued <br /> l the work <br /> rein <br /> Application is hereby made to the San Joaaq Iia ce witheCounty tordinance permit <br /> and existing Rules and tand Regulations- <br /> described. This application.is made in.co p <br /> ... ......... <br /> Phone <br /> Owner's Name •• E <br /> Address -..-._...._. �. '3�._. •... City ..... ........ ... Phone •...._.. .....•_... <br /> . ... <br /> Contractor's Name ................ .... ?u-:�' -_ -..:...._....__..I.........................License # ......................•• •---.......__......._...... " <br /> installation will serve: ResidenceApartment House❑ Commercial[Trailer Court M0 <br /> 'Motel ❑Other ............................ / <br /> Q� A 7 �....----•__.. <br /> Number of living units­-4V Number of bedrooms _�.....Garbqge Grinder .__..___._.. tot Size .. ..... . ... . ..... . <br /> Private ❑ <br /> Water Supply: Public System and name ---�_------• ----------- ----••----------------•- - •••• <br /> Pry to <br /> Peat ti-Sand Loom ❑ I Clay Loam ❑ <br /> Character of soil to a depth of 3'feet- 'Sand U " ,Silt ]'; Clay ❑ ❑ Y <br /> ,' <br /> f` }hard an❑ Adobe Fill Material If yes,type ............................. <br /> AF <br /> {Plot plan, showing size of lot,+location <br /> 'of.-system-in-relation to wells,_bylidir gs, etc. must be plated on reverse side.Tf <br /> _ _��_„ <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 2( feet,) <br /> I <br /> _ � Size....,?._•-x f�...................... Liquid Depth .. ._.. ..................9 <br /> PACKAGE LtREATMENT I ] -SEPTIC TANK <br /> _ . "2. <br /> • � No. Compartments ....._._-. . <br /> capacity/ ......... <br /> Type _ . Material.C ?'t -.... <br /> . .....:.... <br /> Distance to nearest: Well ._Faundafiion•.... .�.:........... Prop. Line . <br /> r �, <br /> ..Q ...........-Length 440-4­.. <br /> to nearest- Well .__. Foundation ..�.0_.• f ....... Property Line .. .................. <br /> ...__-..••••-•._... <br /> • — Rock flied Yes`� No C] <br /> SEEPAGE PIT Depth ..- --..--•• Diameter ....:___. Number ..... - <br /> Depth 7­ <br /> ..............Rock Size: <br /> Water Table De <br /> p ... <br /> t .Foundation _.... Prop. Line . -- --•---•----•- <br /> .................... <br /> "-Distonce to nearest:"Well <br /> REPAIR/ADDITION(Pr Permit# { <br /> ....:............ Date __........_..: ..............._... . <br /> 17 <br /> �a <br /> Septic Tank (Specify Requirements) ...----...:. ----- ..• - .....---...•---•----...._ _.. ._.---•--- <br /> Disposal Field (Specify Requirements) ........ <br /> .......................................... ----------------- --- - <br /> .............•- (Draw existing and required addition on reverse side) <br /> I hereby certify that,Irhave prepared this application and that the work will be dons in accordance with San Joaquin <br /> County Ordinances„State Laws, and Rules'and Regulations of�the San Joaquin Local Health District. Horns owner or liven- <br /> sed agents signature certifies the following: person in such mannet <br /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any <br /> as to become subject to Workman's Compensation laws of California,” <br /> Signed ... _ __ ............................................ Owner <br /> ( ` <br /> B . <br /> If r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> .... ...... ........ <br /> ...:................... <br /> DATE.. <br /> APPi ICATION- ACC PTSD"-i3Y... _.. v,. .. ........ <br /> BUILDING PERMIT 55UED .:.:.......'......:DATE _...................-........... <br /> ADDITIONALCOMMENTS ......................... . :. ..... . ... '. ••..• ................................• ....:...... ................ <br /> ..................... ............... ..._.Date ...................._ <br /> Final Inspection by: � . ..•....._..--••••......•-•.._... <br />