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FOR OFFICE USE: <br /> 4... �.....--1: _ ''.� APPLICATION FOR SANITATION PERMIT <br /> ................. 73 77 <br /> Y.� Permit No. .....-...' 3 <br /> ��` (Complete in Tripiicam) .Y.. <br /> ---......--------------•--.......----......-.....-��.... This'P,ernrit Expires:l_Year FromDate Issued <br /> Dote•l'ssued ... 73 <br /> i 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 Reiulations: <br /> .JOB ADDRESS/LOCATION�..- 7� .r------- 47-f.G���f�lf�......... ............ . CE <br /> .11f. � _ CENSUS TRACT .......................... <br /> Owner's Name �l .f. .... .................................. .. ...........Phone ............._ <br /> Address .- ,J� -...-. City -s. � /Y. ............................ <br /> ' Contractor's Name .... .. .. .. ..._ <br /> ��. �.Licenie #0 �.3 .. Phone� d: � .. <br /> Installation will serve: I Residence Apartment House o Commercicii ❑Traller Court ❑ <br /> Motel ❑Other .......................................... <br /> Number of living units:...-......Number of bedrooms _,:__...Garbage Grinder Lot Size : f1.47X. �Q.. <br /> ( Water Supply: Public S stem and name <br /> _Y_ _•- 1 :`f�� i'E�".. /1nr -••........... .. Private ❑ <br /> ii i <br /> Character of soil to a depthibf 3 feet: Sand-O Silt❑ Clay ❑ Peat❑ Sandy Loam'❑ Clay Loarh ❑ <br /> d - Hardpan❑ Adobe Fill Material ........---_ If es a .............:.............. <br /> . . yes, type <br /> (Plot plan, showing size ofd lot, location .of system in.relation to- wells, buildings, .etc, mus <br /> be placed on. re'`erv�,ide.) <br /> NEW INSTALLATION: (Noeptic tank or seepage pit permitted if,public sewer is 1. <br /> available within 200 feet,) <br /> PACKAGE TREATMENT r] SEPTIC TANK _ Size- '� <br /> Is <br /> �- � a'lr��E � ............. .......iLiquid Depth, . .. -V� <br /> Capacity4-Ver- ---- Type! Materla IJ' No. Compartments <br /> k. r. r ..._ <br /> Distance to nearest: NVe)I �::"....-- ' —'F6ur dation-/� Prop. Line �1 <br /> .............. <br /> / <br /> LEACHING LINEr^ 1i .01 <br /> E In No. of Lines,-....A.............. Length"of each line.__?W471%...... Total Length 1.7z?,__..:..-----... <br /> h ? ` <br /> 1 k,e'D'`t <br /> ox _ "Typ"e Fit te`r.Materiai� e Depth Filter Material .. <br /> i <br /> Distance to nearest: Weil .....:__-�'rT..,..._Foundation gyp.` Property tine ? <br /> ....... 0 <br /> SEEPAGE PIT /� Dep''. Diameter. -._. _Number; ❑ <br /> --,...� _� -� `�` - ;...•�':.......,........ Rock Filled Yes, No � <br /> Wader Table Depth -lt � - Rock Size <br /> Dist nce to nearest: Well ............:. `-`"."' "--F'_ -ti= + _ _ __---__----_•---- <br /> .:.•��..� . .__ --------•-•----- :��.. Prop Line_. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date <br /> Septic Tank (Specify Requirements) ........................-•-...... <br /> .... ............ -----........... ------ <br /> Disposal Field (Specify Re` quirements) ---••-------------------•----_---.-------- <br /> II -•-- -------------------------------------•--..... <br /> ! <br /> ..........-......... .... .. . ---- -- -------------- <br /> -------------- ------ <br /> -----------------••----..._ - -------------_--...-----------.-_-----.-------...-_.-....-._-----------------------. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have;prepared this application and that the work will be done in accordance with San Joaquin <br /> qu n <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifiesi�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 Compe iation laws of California:" <br /> Signed ------------------- -- -•--.......�------- .... - wn <br /> . ----•••---- ------------------- -- O <br /> BY .................. 0� Title ..L'�/{ <br /> ... ............... ..... <br /> (If er than o�hwner) <br /> I 11 a FOR DEPARTMENT USE ONLY <br /> i APPLICATION ACCEPTED BY __l DATE ---.....I_ .y. ........................ <br /> BUILDING PERMIT ISSUED -Al -._ ........................ ....................-•-------------- •-•....... ...................DATE ........................................... <br /> ADDITIONAL COMMENTS ...A ....... <br /> ....... ................. ............. <br /> .. ................ ...... .....-----....... <br /> - Final Inspectionby �k .............. ---••-- -. <br /> ----.....-- Date <br /> ._SAN.J QUIN JOCAL..HEALTH DISTRICT <br /> E.-H-131-'G8_Rev. 5M 3' 7177 3 %r`'� <br />