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s FOR-OFFICE USE:_._ - FO -- _. <br /> A'� — `—APPLICATION R SANITATION PERMIT <br /> b 3\-'1 --_____---------------- Permit No: -- - - - --� <br /> (Complete in Triplicate) <br /> This Permit Expires ares 11 Year From Date Issued Date Issued __Z"_z-. -:--7 L <br /> -------- ------------_---_--- -----------_------------- 7� <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-- made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .------ ' S_ 0, Aa---------------------------------------------------------CENSUS TRACT -------------- ------ � <br /> G <br /> Owner's Name/hii -1�-------- !!1N_ ..h� _h. . <br /> -Phone ----- .....------ <br /> Address ____ _ __ City "--� <br /> --------------------------•----- -------------- <br /> _ _ <br /> Contractor's Name-1------ --------------------------------------------.License .__ Phone 1� '- <br /> Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ',❑ ' <br /> F <br /> Motel ❑ Other -------------------------------------------- c <br /> Number of living units:----------/Number of bedrooms _______Garbage Grinder ___ Lot Size -----------•------- <br /> Water Supply: Public System and name ___ Private ❑ <br /> _ ------ •--- <br /> Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay E] Peat ElSandy-Loam .E] Clay Loam E] <br /> a £ . <br /> Hardpan [D Adobe Fill Material /.(,�� <br /> -- ___ If yes;type -----------------------I y <br /> (Plot 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 sewer is available within 200 feet,) i f <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ Size-----' _Y!_ -- -------------------- Liquid Depth'_7-f ---------------- <br /> "Ilk <br /> Capacity -------- Type - Material, '>~t�-�No. Compartments --� _.--_------ <br /> --_ <br /> P Y --� ---- � Yp { <br /> l Distance to nearest: Well ______— -------- --Foundation -_;t' _`..........Prop. Line _s__��_______________ <br /> LEACHING LINE No. of Lines ___ Length of each line-___ f Total Length ___�__1�- ----------- <br /> -------- <br /> g / <br /> D' Box _ r__ Type Filter Material - Q_c -----Depth Filter Material ---}.Q___-------------------`___......... <br /> Distance td nearest: Well ------------------------ Foundation ---=----- Property Line ___- -------- -------- <br /> SEEPAGE PIT Depth a- -------- -Diameter- _ ------__ Number _ Rock Filled Yes No <br /> Water Table Depth - . -• - --------•-------.Rock Size f -�C _ <br /> Distance to nearest: Well ------- `---------------------Foundation -- ------- <br /> Prop. Line ... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------ ------------------------------------- Date ----------------------------------} <br /># Septic Tank (Specify Requirements) ---;--- -----_-----------_------------------__----------R_---------------------------------------•1----------------•--------•- <br /> T ---------------------------------------------------------------------------------- --------------- f <br /> Disposal Field (Specify Requirements} __________________________!_______ , <br /> --------------------------------------------------t-------- ----------------------------------------------------------------------- --------•----- <br /> - ----------------------------- <br /> --------------------- -- <br /> ------------ ------- ----------------------- -- ---------- -------------------------------------------=-------------------------------------------------------------------------------- ----------- <br /> r l (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I haye._prepared this application and that the work will be done An,accordance with San Joaquin <br /> County Ordinances, State"Lawa, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the followings F , <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of;California." <br /> Signed ----------------------------!------------ Owner <br /> I _ _. = Title <br /> BY --------------------------- ---- a[�- �— `--'�"" T. i <br /> (If oth an ner) <br /> i f FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --1 - ------- --------Y-r��r3_ G --------=---------------------- -----. DATE ------ 72n_ - <br /> BUILDINGPERMIT ISSUED ----------------------------------- i ----------=---------- ---DATE - ----------------------------------------- <br /> V <br /> NAL COMMENTS ` - <br /> t -------------------------- <br /> ---------------------------------------------------- <br /> - <br /> ---- ----------------------------------- <br /> R . - oma. .__ -= - - °��° f __ _:'_ ' <br /> ------------ ---- ------. <br /> 1 <br /> Final Inspection by: _ _ - F Date ----- -1-�---- - -------------------- <br /> ------------------------- -------------- ' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> A,,X e_•. '' .10 <br /> T E. H. 9 1-'88 Rev. 5M. __- <br />