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I <br /> FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> n. <br /> ----...F_.-._� '...............E=--=-------.1-- er <br /> (Complete In Triplicato) <br /> P mit No. <br /> 74 A.a <br /> �I� -..- This Penult Expires 1 Year From Date Issued 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 exlsfing Rules and Regulations: <br /> JOB ADDRESS/LOCATI N...../-.� / S-S � .:.. ..-.. CENSUS TRACT <br /> .. ... ........ .... ............................... ..................--- <br /> �Tsr-. .s�o.. <br /> Owner's Name ...-.. f/l!g� �....-.. ...........................................,.....................................Phone . <br /> .. ..............I.......---.:City ... ..............-•--------...... ........... <br /> Address . ............... <br /> ' <br /> Contractors Name <br /> t �M�.... --- -- .5. ........ License , .. .. Phonet`2.�.YJ4 <br /> 4 <br /> Installation will serve: Residence Apartment House J3 Commercial ❑Trailer Court ❑ <br /> r Motel ❑Other ....... •---- ------------••---- <br /> Number of living units:-.'>:! .... Number of bedrooms 3 . Garbage Grinder Lot Size / <br /> Water Supply: Public Sys tem and name ..... ...................................................... ........--.....f........Pr ......... <br /> P Y� .I ❑ <br /> Character of soil too deptP�of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam <br /> i Hardpan ❑ . Adobe, F111 Material ............ If yes,type................ .......... . <br /> 'I� <br /> IPlot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewers available within 200 feet, �� <br /> PACKAGE 'TREATMENT [ SEPTIC TANK( ize..._.-.._- K l_ ----•--•............ Liquid Depth ..� .............. <br /> Capacity _lb'p°�. Type ..14....... ....... Material.._ —. No. Compartments .. ............... <br /> i _ <br /> Distance. to nearest: Well ....................................Foundation .._. ............ Prop. Line ............. ....... <br /> LEACHING LINE N... of tines -.-.- -.-------. Length of each line.....& .�.............. Total Length ......70.-.•__........... � <br /> ✓ yp XN ..Depth Filter Material �, <br /> 'D' Box ......-..... T e Filter Material ..... <br /> . �i► <br /> Distance to nearest: Well ........................ Foundation ---l.Q...?'�........ Property Line ..�D.............. <br /> SEEPAGE PIT D I th _/..0..--♦.............. Diameter s r <br /> Number ....... ........... 'Rock.. Filled Yes No <br /> 0 <br /> or <br /> Water Table Depth ....... .. . .............. ----•---Rock Size1 .......... oe <br /> z <br /> p <br /> Distance to nearest: Well .........Foundation Prop. Eine :.... .............. p <br /> f <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ...................................} [ <br /> i <br /> SepticTank (Specify Requirements) ------------------- -----•-----------•••--- ...................................... -•----..................... ...... ....................... � <br /> Disposal Field .(SpecifyRequirements) ........................................................................... <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 /> County Ordinances, State laws, and Rules and Regulations of the San Joaquirw Local Health:District. Home owner or liven• <br /> secs agents signature certifies the following: <br /> ' "t 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 /> is . . <br /> Signed ------------- I ---------- . •------------------------------------ Owner <br /> jBY --- ------ -- - ------I ---..-..._..----- Title .... ..-_...-------- <br /> ll other t `` owner) <br /> R ICPARTMENT USE ONLY <br /> E <br /> APPLICATION ACCEPTED BY ------ DATE _.:./.(- ..a3.- <br /> _. . <br /> BUILDING PERMIT ISSUED-- --------- .......-DATE ------------------------------------------ <br /> ADDITIONALCOMMENTS'------------- - ----------...:...---------------------...------------------•----•-------•----- ----•-- ------.. ............ ............................. <br /> -------- - - <br /> Final Inspection b 'I Date .-..-...../. .. -. .4.. .. .----••---- <br /> y: .... i .....- . ----•................:...........----.............----•........ / <br /> F T 3 2t� -6 ] v�M 5 SAN J AQLiIN LOCAL HEALTH DISTRICT ��7)1 3M <br />