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_a <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />...........•-• •--•....-...... ••••..................... Permit No. ...`.. <br /> (Complete in Triplicate) <br /> i <br />......_.-�._.�.............................----....... <br /> Date Issued <br /> •...............................•-------. This Permit Expires 1 Year From Daae Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein - <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: ' <br /> JOB ADDRESS/LOCATION �'� C�►rY Tp�!! t�`.....................CENSUS TRACT <br /> Owner's Name -........ "a/5/V 'tl i 7!' �'�}%3 YT::....._ :.. �.�....... �....Phone .. . . � -.._.... <br /> . . <br /> Address /` e1. ty f7'/>7,V... ...` i <br /> Contractor's Name ._., �-.l f .�/.!dl�!�/ `TG 'IfG .._.... .. - ..License# ..........:.: Phone ........ <br /> installation will serve: - Residence.0 Apartment House C1 <br /> Commercial❑Trailer Court -0. <br /> ­ <br /> Motel []Other ...'................__..:;:......:::...::..... <br /> Number of living units:..../------ Number of. bedrooms..:3_.....Garbage,Grinder ............ Lot Size .._ _ .. Y <br /> Water Supply: Public System and name _...:_ ---•- : .....,....... :...... .. ___-- Private IV <br /> P to <br /> Character of soil to a depth of 3 feet: Sand 21 Silt❑ Clay ❑ Peat❑ Sandy Loam,0 Clay Loam Q <br /> Hardpan ❑ Adobe ❑ Fill Material ..:.......... If yes; type ....-------:____..-_________ f <br /> (Plot plan, showing size of lot, location of_.systern .in relation,-to.wet ls, buildings, etc... must be placed on reverse side.) f <br /> NEW INSTALLATION:` +(No septic tank or seepage pit permitted.if`public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size.....�.�-�h-9..........•---•-•••••. Liquid 'Depth ..__.y`............. 01 <br /> Capacity Type Material____CB_ _C:..: No: Compartments ...'Z................ <br /> Distance to nearest: Well ...... ___........._•........Foundation Prop. line ......... W <br /> LEACHING LINENo. of Lines ..... ...... Length of each line.. �••(a'3p Total leth <br /> ng <br /> [ ] 9 f <br /> •D Box ..../------- Type'FiIter Material R G-:' ....Depth Filter Material ".--_•--.�4...................... <br /> Distance to nearest: Well Foundation 3--________. Property Line ........... <br /> SEEPAGE PIT "[ j Depth -------------------- Diameter Number ---:........................ Rock Filled Yes No l] ` <br /> Water Table Depth ....----..Rock Size ...................... r <br /> Distance to nearest: Well ------------------------------=---------Foundation ...._..__.._:---..._ Prop. 'Line .................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit°# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ...............:............ -------------__:................................•......................................._................. <br /> -D <br /> DisposalField (Specify Requirements) ------- -----------------•----------------------=-••--------_-..--------.._..._..---•----•---........._..••-•-•--••--•---•--•--...... <br /> ----------------------------------------------------------..._. .---------­------------- ................... -----------------------------------------.......... .................................... <br /> -----------------------------------------------------•-- ----•------------------------•----•-•-- ••--••--••--.............-- _.._. <br /> -••••••---------- --.............--••------------. ..................... <br /> y (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 /> County Ordinances, State Laws, and Rules'and Regulations of the San Jboquin Local Health District. home owner or licen- <br /> sed agents signature certifies the following: j <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." <br /> Signed -------- = : Owner <br /> 7itie - <br /> ------------------------------------- <br /> (If other t a er] � ._ • � . y ' <br /> F DEPARTMENT USE ONLY � <br /> APPLICATION ACCEPTED BY .__. DATE IL_~1 g�?y <br /> . ... -••... ......................... <br /> BUILDINGPERMIT ISSUED ........................----------------=----•----------=---c......................---=-•-•-•-----•.......---DATE ...........................,............... <br /> ADDITIONALCOMMENTS ........................................................ ---•-------------------------=-- -_...................-----------------:........:..............-._-... <br /> ____---•---------------------------• ----..........._. -------------- ----------------------•-•---------• -------- ...................---•.............................,. <br /> -- } • <br /> ............................ to .-. ........ '".�................. <br /> Final Inspection byh. ........................................ <br /> W SAN JOAQUIN LEALTH DISTRICT . •_. <br /> .. "" <br /> Ir c u 13 241-'AA Po.,. RAA 7/723 .K <br />