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-1OR OFFICE USE: <br /> (APPLICATION fOVSANITATION PERMIT <br /> ....-•--• ... ..........................••---... 'Permit No. <br /> v _... . _ No.Trlplicatiil �._ _ _v ..F.� - <br /> - Doti issued .l`__�4.`..:.... <br /> ...... .......... .............................. Thit PermltExpires 1 Year From Date Issued <br /> Application is herebymade to the San Joaquin local Health District for a <br /> q permit to construct and Install 'the work herein <br /> k described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRirSS/LOCATION ..�/1 �. .42. t� a-L.. . .. ........... --.-- -•:•- CENSUS vRACI' .. _...:........ <br /> N . ............. <br /> Owner's Name ..............I......•.........:..:..:.....................Phone <br /> m Address 1091Q' ...City G" -------•---- ----------------------- <br /> Contractor s <br /> -------- --•-------Contractor's'Norne <br /> _..License# ................... Phone- <br /> Installation willNerve: Residence©Apartment House Commercial QTrailer Court 0 <br /> h Motel ❑ u Other ' ..... <br /> Number of living units -.`__� Number of bedrooms Garbage Grinder...✓... Lot Size ..... ,e `..... <br /> Water Supply: Public System and ni me •............... ........ ........_.. .............._......_..... ............Private <br /> Character of.soil to a depth of 3 feet: Sand's Silt❑ ClayY0 k`•Peat Q„•',Sandy Loam{ Clay Loam Q # - <br /> Hardpan A�obe�j CFlll Mpiter€al ...--..... If yes,type ............... ............ <br /> r -., w <br /> (Plot plan, showing size of lot, location of tystetrt ln,relatianta wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitteil If public sewer,.iaavailable within 200 feet,) y s� <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size_._ ...... ................... <br /> :. . :.........: = ...... . Liquid Depth <br /> '� N <br /> Capacity!.2aU_._.... Type.; E#F Material.-Claws _ No. Compartments ----.-Z:........ <br /> l ` o <br /> Distance.to nearest: Well ....... ..................Foundationf .: Prop. Line ... N <br /> LEACHING LINE No. of Lines ...... __:... Total Length <br /> Length of each <br /> 'D' Bax ---1____ Type Filter hAateria ,�'!?'yDspthAlter Material . . ................. ..j.. . <br /> r rw�= Distance to nearest: Well _.. ° .._...... Foundation ... A"f9 --------- Property Line ....4�.......... a <br /> ' [ ] Depth Number ........ Rock Filled Yea No ".- <br /> Water Fable Depth ............................. ...... :.”....Rock Si z� .....-?...�Pu!� d <br /> �r ' <br /> Distance to nearest: Well ---_. ,.,--:...�----...: Foundation ...1 ...... Prop. line .. ......... <br /> REPAIR/ADDITION#Prov. Sanitation Permit# ...................... ........... . _ Date ......,z__:--;---•---:--•••,...... <br /> Septic Tank (Specify Requirements) ----•------ --+ ._....�: ------ <br /> Disposal <br /> ----., <br /> Disposal Field ;(Specify. 1?6quirernents) ---------•-•---- -.,::7.......... '- -------------------------------------------- ........-------••-•--- <br /> ---------- ---------------- ................................................. ------•-•• ........................ <br /> ------ <br /> •--•.................•------------_-_-_.----------•---•-- -- ................... -------------------- ---- .---- ..._..__._._._. ._--•-----•--- <br /> (Draw existing and required addition on reverse side) va <br /> I .hereby certify that I have prepared this application and that the work will be done in,ccardance with San Joaquin <br /> County'Ordinances, State Laws, and Rules and Regulations of the San Joaquin tical Health-,district. Home owner or Ilcen- <br /> sed agents signature certifies the following: r <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 biect o W rkrnan's C pensation taws of California. I <br /> Signed � <br /> ----- - - ---------------------------------- Owner l I <br /> By ----------------------------------------•-------- :........................ title __ ._._._^: <br /> (If other than owner) - <br /> DIE0 TMENT USE .ONLY s� <br /> I APPLICATION ACCEPTED BY -.. ._�,_. . ..�.._ i - ------..DATE. ... <br /> BUILDING PERMIT ISSUED <br /> ----•-• --..-DATE <br /> ADDITIONAL COMMENTS __ .. >,� <br /> ---------------------------------------------- --------•-• • - ----------- ---------------. --------•....--- ----•---•-- - ---------------- --------- ------------•---------•--_.._.-••--•------ <br /> .... -_-.-_.--•-•-•--••---- -.-•------------••---------------------------- <br /> ' final Inspection b Date . `� , <br /> y: ..._. 1�. .................... l _.................._ <br /> .' 21� 1"�' SAN }OAQUIN 'LOCAL HEALTH DISTRICT 8/7�, 3M <br />