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-'�TFOR I�F�IC�USES- <br /> APPLICATION FOR SANITATION PERMIT Permit No. .. `� <br /> _............... ............_................. (Complete In Triplicate) <br /> .... ..-•--- .............•- -.................. � Date issued Z°............. <br /> .......---••--•••........................... <br /> This Permit Expires 1 Year From Date Issuod <br /> Application is hereby made to the+Son Joaquin Local Health District for a permit to construct and install the work Iretsin <br /> described. This application is made In compliance with-C u ty Ordin nce No-­549 and existing Rules and Regulations, <br /> ......... <br /> CT ................. <br /> JOB ADDRESS/LOCA ...... <br /> sJ. . f,�. ......... <br /> .-.. --- NSVS TRA <br /> _. �' ._._........ .. ....... ......' ........ .Phone ......----.......`..e..2............... <br /> Owner's Name ..... _ <br /> ..... ......_._..Cit . ._... .. . ... <br /> Address <br /> Contractor's Name ...... . ......................... ._:! <br /> icense# <br /> 7fs3 Phone _ <br /> Installation will serve:•• Y-- Residence- fl Commercial(]Troller Court 0 <br /> mate <br /> I-C]Other.................. <br /> -�:....Garba a Grinder _..._....... Lot Size •�C,�-------------- <br /> Number of living uni4g:. �_.... Number ofzbedrooms_T•.e„,� ...._._�._......_.-•..........................•--•---.............. <br /> ._ <br /> Water Supplyt Public System and name --- .Private <br /> ...................•---•------..-- <br /> Character of soil to a depth of 3 feet- Sand 0 Slit 0 Clay [3 peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> u <br /> HafdpanQ .Adobe Ga-11�J11 Material ............if yes,hype............... ............ <br /> (Plot plan., showing size of lot, location of system in relation to wells, buildings, ate. must be placed an reverse side.) <br /> k ' it ermitted 1f-public sewer is available within 200 feet,i <br /> NEW INSTALLATION: (No septic tank or seepage p p pf ,� <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{ ] Size................................................ Liquid Dept ........................ <br /> Ta- <br /> .. Material...................... No. Compartments .................... <br /> • Distance 'to nearest: Well ..Foundation Prop. Line ...................... <br /> TEACHING LINT: [ ] No. of Urias •• -: .:�LangtTi�of oath line............................ Total length ......................... <br /> ry 'D' Box ............ Type Filter Material Depth Filter Materia ............................... .........16 <br /> a l ce to nearesh Well ....................... foundation ........................ Property Line .................... <br /> Di scan - . <br /> ' Diameter, .... Number ............................ Rock Filled Yes ❑ No <br /> kSEEPAGE PIT Q Depth .......:........_.:: • i <br /> .�......�..._ Water Table ..Depot, _............Rock Size ................................ <br /> Distance to nearest- Well .....................................Foundation ............ ....... Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..........................................:. Date ..................................I <br /> Septic Tank (Specify Requirements) ............. .... ............. .-........_... ...........•...�.....�a.�•...:. . ............... <br /> Dispose) Help (Specify Requirem ts) ... .... ... ...... .......... <br /> .. . .. . .. .... . ...... .......................................... <br /> ......................................... <br /> ........................................ •--------••. ................................................- •..... ...........•..............................._................... <br /> ' (Draw existing and required addition on reverse Oclol <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> F county Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or [iten- <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 /> Bays to beta ub act o,Worktnti Cour ensation laws of California." <br /> signed ... .... ............ .:.... <br /> ..Z. <br /> ................ Owner <br /> 3itle <br /> (If other tha caner( <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- - DATE ......... .. ...31 .....: <br /> .......................... .....---•----- <br /> BUILDING PERMIT ISSUED ........:.............. DATE .:............-................. <br /> ................. .. .. <br /> ADDITIONAL COMMENTS .._...................---- <br /> ............. <br /> ........ .:--.......--- - - ----•----- --------:_.---------... -----.................................. .... . ate <br /> 8/7h 3M <br /> --. D <br /> Final Inspection by. . �' • .........: .......................:............ g <br /> EH 13 A 1--61 ifay. 5H SAN JOAQUIN ^LOCAL HEALTH DISTRICT <br />