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r FOR OFFICE USE: <br /> r APPLICATION FOR SANITATION PERMIT s <br /> 77-9 <br /> (Complete In Triplicate) Permit Na. •------------- <br /> ;. 1$ Date Issued �...:-.�. <br /> ............................................ ..... TMs Penraitfxplres t YearFrom 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 applicotio." is mode in compliance with County Ordinance No'. 549_arid.existing Rule.0_alnd Regulations: <br /> JOB ADDRESS LOCATIOW ...>......... <br /> Owner's Name ......... �. !7"!.i� f/........................ ...... ............-�...Q. /.� .. . .Phone'"�7��I .��7dr~------ <br /> Address ..............��CU ..��.. ...�_o `C.�' ± ��1...._. ........_.._........... City .....S�t.�!'S�_P?�:...... <br /> Contractor's Name ----- - u/� x � '.......�.........................license #5.7.. .22V..E Phone!..o- " <br /> i s I --. <br /> Installation will serve: Residence gApartment House Commercial OTraller Court 0 <br /> ' Motel ❑Other... . .. ................ , <br /> Number of living units:..- -- Number of=bedroo9A. <br /> __...-:Garbage Gri ad r_............. lot Site .... �X_f :................ <br /> ,/�''��y /_W ;1..11.... •. *.afar Supply: Public System and name . ' ::........... ...... ......_._.... ...... . .Prtvate❑ <br /> t <br /> Character of soil to a depth' of 3 feet. Sand Q Silt❑ Clay f5 Peat❑ �5a dy=.Loam❑ Griy loam Q <br /> �. I <br /> Hardpair j] Adobe ❑ Fill Material ............ If yes,type...........>::.. ............ <br /> (Plot plan, showing size of lot., location of system in relation to wells, buildings, etc. must bye•placed on jir erre side.) <br /> NEW INSTALLATION: 0! f <br /> (No septic tank or seepage--.pit permitted if public sewer is available withfp 200#eet,I; �t <br /> PACKAGE TREATMENT j ] SEPTIC TANK f ] Size_........................ ... Liquid b D4pth`. .....:.. .......... <br /> _ Material-----------------•--.. No. Compbc#atents <br /> Capacity .._....-•------ - 7YPe- ......_..-•----. � � <br /> Distance to nearest: Well ....................................Foundation 4--P,dine ...................... 6 <br /> LEACHING LINE [ J No. of lines ......... ---­-------- length of each line--—....................... Total length" .t......................... <br /> 4 <br /> D' Sox Type Filter Material ...Depth .Filter Material 3 .................. <br /> `` .......:_... Property line <br /> � Distance to nearest: Well ........................ Foundation ......._.... . ...................... <br /> SEEPAGE PIT`' [ ] Depth .................... Diameter ................. Number -'I............... .. ..... +Rock Filled I Yei. ❑ No cl <br /> Size .---------...� ............... <br /> � ; <br /> Water Table Depth •-•....:...................................Rock .:, <br /> JI: f <br /> Distance to nearest:;Well -----.------_ ........................ Foundation ---------........... 'Prop Line ......................� <br /> REPAIR/ADDITION(Prev. Salnitation Permit�# ~''� ....._ _.__ Date ............... <br /> ,. ,,// <br /> Septic Tank (Specify Requirements)..........����.xr.nT!::�.............. '�"�. .`...._�l`_..........•�;�_ <br /> ! Disposal Field (Specify ilRequirementsKz.)....... ------ /��.�:......- Olc ------ ------------ ------------ <br /> ....................................•------------------------------- --------------------- <br /> ----­-------------- <br /> r <br /> I___________________________ ----------------------------- <br /> ______ ___ <br /> i (Draw existing and requirecl.additlon on reverse side) 1 <br /> i 1 hereby certify that I ha� prepared this application and that'the work will be done Inccordanca_with San loa�uln <br /> ' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horne owner or licen- <br /> sed agents signature certifies the fallowing: ` <br /> "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such rnanner <br /> s as.to become subject to Workman's Compensation laws of California." ' k <br /> Signed ------ ••-•... . ......... . ............... Owner <br /> .I I <br /> _- litle ---- <br /> } By .............. <br /> { f other thorii`'owner - <br /> II PARTMIENT USE ONLY: _� <'� <br /> APPLICATION ACCEPTED BY _____-. --- J' <br /> DATE ..,�.�-•.--� - °�/- ----•-•-....,__..._ <br /> -BUILDING PERMIT <br /> : ISSUED! <br /> ---------- <br /> ------ ------------- ...... ---------------------------------------------------.-DATE ----__--- <br /> --------_- ..........Z. <br /> ADDITI AOMMENTS ___.__. _ . <br /> r ....... .........::.:. ......... .: ................................. ......_...............:_ __....::_::_......:_: .il-;. • -- _.. :_ . ::.. . ---- -- •------ ......-- <br /> -----•---- i ..--------•.- -- ---- -• - -- ---•--- -- ------ ------------------------------------•--------------- <br /> Final Inspection by: .---------- -------•-- ....................... . •---._.._.._...,_._...------Date _.. �,?'= 1. ....... <br /> Ell <br /> 13 1-68 S OA IN LOCAL '-HEALTH DISTRICT 8/7h 3M. <br /> ��F <br />