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FOR OFFICE USI:: .I� " <br /> ................... .. . . <br /> APPLICATION.AMR-SANITATION PERMIT <br /> {{'''''``�� (Complete In Triplicate) Permit No. <br /> �.. <br /> Dote Issued <br /> .74.' <br /> .... ........... ... This Pennit Expires I Year From Date Issued' <br /> ••� 'as <br /> Application, 3iFiy7rctdato the San.Joaquin Local Health District for a permit to construct and install the work herein <br /> described. )T) Is'appIicgti on <br /> "' is .made in compliance with County Ordinance No. 549 and existing Rules and Regulatlonss <br /> i ), .I <br /> MI <br /> JOB ADDRESS/LOCATION': ... .�.�....: :...... . hQ.....QA._...--•-----..............................CENSUS TRACT ..._...................... <br /> Owner's Nome).........:.......�� . . d. -C'� O S........... ...................... .......Phone <br /> Addressx ------... • -•..................... .................. <br /> / <br /> ,contractor's Name ---•-•--....��-.�.c.�..��^__..- -••- -•.................................License # ------------------------ Phone ---- ..............-. �1 , <br /> ' Installation will serve: Residence fig kPartment House[] Commercial []Trailer Court ❑ <br /> 1 _ Motel 0 Other---------- - •-• - <br /> Mb� <br /> Number of�living;units:;--- ,`.....Number of bedrooms.----.._-:.Garbage Grinder ........... Lot Size t------------------------------------------- <br /> Water Supply: Public System and name'-----_..:._ ---------•-------------------•--•-:----..-_._ ...................Private <br /> ❑ <br /> '!�` <br /> Character of soil to a depth of 3 feet: Sand o Silt❑ -Cloy-,.0 Peat'❑ Sandy Loam o . Clay Loam ❑ <br /> .. r +�❑.. ". = .'.r" <br /> Hard" an �dcbe Fill at yes,type.. <br /> (Plot plan; showing.size of"lot, lgc�btion of system in telotion to wells, buildings, etc. most be placed on reverse side.) ! <br /> NEW INSTALLATION: (NoM septic tank o seepage pit permitted if public sewer is available within 200 feet,) i <br /> PACKAGE TREATMENT, [ � SEPTIC TAN l Size....................-----------------•---- .----- Liquid 'Depth .....---•--•-- ; <br /> Y Yp ' Material--------------_.___-._ No. Compartments .............._._ <br /> Capacity <br /> ` <br /> T e • <br /> .M' <br /> Distance to nearest: ell .............. Foundation .--•--••---•---•---.•-.Prop. Line --------.......----.. <br /> LEACHING LINE [ ) No: of Lines Length of h line--------------------........ Total Length .............. <br /> 'D' ox ............ Type Filte Material ...............•_•._Depth filter Materlal . .................. _ <br /> yI _ ...__ ._� <br />• i ` <br /> Distance to nearest: Wali ...... ...Z............ Foundation ........................ Property Line .....................0 <br /> SEEPAGE PIT [ J Depth .....:.............. Diameter` __........_.... Number ......._ ................... Rock Filled 'Yes ❑ No i❑1,A` <br /> Tyr ,I� .'h• r <br /> Water Table Dept . .................Rock Size ••-- .....-•---------- <br /> Distonce to nearest: Well ---- ...........................Foundation ............-....... Prop. Line ..................... <br /> REPAIR/ADDITION lPrev. Saltation-Permit# .......... ---------------------------- Date .... __:---____---___) . Q <br /> Septic Tank (Specify Requirements)J. ----• .... ice----- Y � f� � lr.�O-0_4pp ............. .....:........................ <br /> 1 <br /> Disposal Field.(Specify Requirements] ... --------•---------------•--------------_..--.........._----•---- <br /> ------------------- ---------- �. r► :R .L3.F--p.-•--- -------- --- 5s...._._ ......_ .......... ......___....- --- ------ <br /> rr <br /> (Draw existing and required'addition on reverse side) <br /> 1 hereby certify that-I�hav prepared'this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son .Joaquin .Local Health District. Home owner or licen. <br /> sed agents signature certifiis the following: i <br /> `,certify that i e perforei'once of the work for which this permit is issued, I shall not employ any person In suck manner <br /> as to becomejObjec a Warkmo 's Comp ws of California." p�DT 5�A`�`� <br /> SigneX...-- .. .. --- Owner <br /> - <br /> } <br /> ��I...._....-•-------------- title <br /> SY • _..._- <br /> (if other-than.:owner] <br /> 'll FOR DEPARTNIMT USE ONLY <br /> i <br /> APPLICATION ACCEPTEDB . . . . .. . _.... . ........ ------...DATE .._�.;. s=-2_ `.............:... <br /> BUILDING PERMIT ISSUED --------------------- •................DATE ........................................ <br /> ADDITIONAL COMMENTS ...._..._ <br /> --•----- ------ --• -•..--•-•---•.......................•----.._......--------- -. ----- -----•----- <br /> ----------------------------------- ._k- - --•------•-•- ----------- ----------------------------------------------•••-•----•--------•-•--•-------------- <br /> C ............. = -iM ^}+C� <br /> Final Inspection y: •-------•----••-•-•-Date _5............. ..... ... <br /> EH 13 -6 'r• 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />