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FOR OFFICE USE: APPLICATION FOCI SANITATION PERMIT <br /> Permit No. .1 <br /> .......-----...................................1.._..... (Complete in Triplicate) <br /> r.. <br /> i <br /> ......... Date Issued o2.:.P•7 7 <br /> This Permit Expires I Year From Date 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 /> �1 ,. � (.,' ( CENSUS TRACT ...................... .. <br /> JOB ADDRESS/LOCATION .. 06. -- , <br /> �. - �� � ....r�..�._'`'- . t�_ _ _... _.Phone .................................... <br /> ..�. (.�� <br /> Owner's N me11 .... r <br /> Address . - ....3.� .1.�^?. . City _. �. �_...._.... a .{.� <br /> fi- Lf .Licen­44se # Q �� ��... Phone <br /> Contractor's Name ...._A_._...R.A..... \-�;•. _.•.. ......--- <br /> ... <br /> Installation will serve: Residence &Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel,[3 Other ............................................ , <br /> Number of living units;.---..... Number of bedrooms __3__.....Garboge Grinder ........... Lot Size ............... <br /> Water Supply: Public System and name r_......----•- ...----•-... ......................... --.........,......,.--••- -_....-- .......... Private C3 <br /> I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Cloy taam <br /> Hardpan C] ',Adobe [] Fill.,Material --_-_----- If yes, type ............•----------- <br /> ---- <br /> �. i <br /> (Plot plan, showing size of lot, location.of...system in remotion to wells�';,-buildings, etc. must be placed on,reverse side.) <br /> . . , 200 feet,} <br /> NEW INSTALLATION: (No septi ' tank or'see a e it ermittedf ublc sewer is available withinc <br /> PACKAGE TREATMENT [ ] Siae...� .. .............. <br /> . Liquid Depth _ <br /> SEPTIC �41 <br /> �--- ��-� ................... <br /> Capacity __ . -`hype ...... Materials. o en <br /> , _ No C mpartm is <br /> ....Foundation ...._ ...---•.._llz� rap. ... <br /> Distance to nearest:, Well _.._._. .art. P Line .. ..... <br /> r`. Length of each i�ne._.._ .-,1�.-- --• 7atal length ..... ...... <br /> LEACHING LINE No. of Lines -` -- --•- 9 <br /> 'D' Box Type:Filter Material ,� K. ---- <br /> .�ounclation <br /> Depth` Filter Material '...� •---•----a ; Pro a LineDistance to nearestotWell ._. rf....... . ------..... -- Property <br /> •--••••-----.-- <br /> Number .> ...._ ..:� R k Filled Yes No <br /> � [ ] Depth--,L�.��� 4ameter �� � f <br /> . — <br /> Water Table Depth __ Rock Size <br /> Distance to nearest: Well ... ...........................• <br /> ..•..':Foundation 4 -------_--------- Prop.-Line . <br /> Date <br /> ...�. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# •••------------• F <br /> a ....--•,...__....•...... .....-- <br /> Septic Tank (Specify Requirements) ...........•....... <br /> Disposal Field (Specify Requirements) ••- <br /> `.... , <br /> t -------------- --••--• •---••-•-- . <br /> .......... ......... ---------- -------- ..................... ••---•---•-•---••-•-----..... <br /> ,. <br /> ............................:.s_..------------•-----------....••-•---••-----..._...-------._.._.... ........ <br /> (Draw existing and required addition on reverse side) <br /> 3 <br /> I hereby.certify that t have 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 San Joaquin local Health District. Hoene owner or licen- <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 /> as to become subject to Workman's Compensation laws of California." w �� <br /> Signed _. __ Owner <br /> ._ G`�a... . Title ..._.. :............................. ........... <br /> By -... _ .......... ...... ! <br /> (If oth r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE - s-:. .. .. <br /> .......................r <br /> APPLICATION ACCEPTED BY ..__._.:. _._ .._.. ...---- •• ......•_ _... <br /> • - _..,.....-•---.:..DATE ...............:.. <br /> BUILDING PERMIT ISSUED -------• .........---• .................... •--•--••------••• ..:......._ <br /> ----••-•---------------------------•._.....------......-•-•-••••......_...-•---.....------ .•-*-. -':_...... <br /> ADDITIONAL COMMENTS <br /> ................................................. <br /> ... .......... ......••-••-_..... _ _ ....._..................Date ..-._ ------ <br /> ----------­ � G...�•-..:• <br /> ....-----•- <br /> Final Inspect,on by: ....... G��.�. <br /> w _ SAN JOAQUIN LaeHEALTH DISTRICTCA <br /> : <br /> .. <br /> y C U 13 24 1_-.ca RPv 5M ---Z, 7172 3 M a - _ - <br />