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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6 <br />............................� .f�_�_...---------- .-73.��.... <br /> (Aplete in Triplicate) Permit No. <br /> ......................... �t <br /> ...... This Permit 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 existing Rules and Regulations: <br /> i <br /> JOB ADDRESS/LOCATION ...... . .. $ �---- Pyr-t{rs©f 1 114`x'... .. J ..............CENSUS TRACT <br /> q <br /> �... ..-1. 6Q�R ----••-•----•---------- Phone :.. ..7 7'. _ 67..... <br /> Owner's Name ................ ...... ._.. .. • . <br /> .. Cit s�y�ewen±............... ........ <br /> Contractor's Name -• ---• ••- 1 ............e! kA, <br /> .•-._------ -._....-•------------�---...--- Y --......,.-•-------... <br /> Address .........:.. . <br /> _. RYCE'560� i_41br _.License # �r-�- �� � Phone ..tA-G�....T �-�- <br /> Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ <br /> Mote l <br /> Number of living units:.......... Number of be oms .. Garbage Grinder ...... Lot Size .... ............................... <br /> t r _-__-.-Private <br /> Water Supply: Public System and name ..-.. .: ..� �---- -- -------------------------------•-----.-.-......------------- ❑ <br /> Character of soil to a depth of 3 feet: �San�❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe', Fill_Material _._...._ If yes, type ............................ <br /> -r�.. <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 204 feet,) 1 <br /> PACKAGE TREATMENT [ I SEPTIC TANK-T j Size._... ---:--........................... Liquid Depth ..................... <br /> Capacity ...... Type -------------------- Mat- at...... -.- No. Compartments .......__...........pp <br /> Distance to nearest: W611 .`. .`° ''-- _____-,.._Foundation.,:,,,.g .-..-- Prop. Line ................ .. <br /> LEACHING LINE [ ) No. of Lines - Length of,each,�iine..�_.► Total Length ...__....................:. <br /> 'D' Box Type Filter Material ...............4_.._Dep't0rilter Materia! ..... -..--•-----...--..--.-_._........._--- <br /> Distance to nearest. Well ...........:.....•------ Foundation) _... ...----.-_------- Property Line ........................n <br /> SEEPAGE PIT [ ) Depth t p, <br /> -- .-_-..._ Diameter --------------�- Number _.f.:-.---�.�+.....:.....__ Rock Filled Yes ❑ No <br /> Water Table Depth ................................... .....---.....Rock Size .....--...............•......... i <br /> Distance to nearest: Well ............--------------i--------- ..Foundation ............ ....._ Prop. Line ........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit --- -=- jJ ! Date! __.._.._.__!_________________--.) 1 <br /> .---_-- <br /> Septic Tank-(Specify Requirements) .........1...__--.,...._?- _ I eo:aF <br /> r ............ �Y•"�cx3 ......._.................. <br /> „ . <br /> Disposal Field (Specify Requirements) ... ------ .C�.'... -- = o , <br /> ............ . . .... ................ ......... .........­_.. .......--.........------------ --------- <br /> (Draw existing and required-additiori 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 Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 WorkmarVI Compensation laws of California." <br /> Signed ..... ._ ----------------------------- <br /> -------------------- Owner <br /> By -. ..... ------------------- Title . --. ------- <br /> (If o er than owner) <br /> FOR DEMPART USE ONLY <br /> APPLICATION ACCEPTED BY .:� - - - --•..... .................. DATE _.._._._ <br /> . ...... <br /> BUILDING PERMIT ISSUED ................ .... •------------- - ..-...-.DATE ............... ..........-- <br /> ADDITIONAL COMMENTS ............ ------ ------- --------------------------------- ---------------------------- ........•..... - <br /> ------------------------- ------- --------------------- ----• -------------------- ............... .....------..-....__......_..--- •---•----..._....._._...._.................... <br /> ---------------- ------ -•------ •- ......................................... .................... ....... ............. ..........------........ <br /> ............... ......... ........... / . . <br /> -Final Inspection by: ... _-.._ -.- --_..._Date ...- :..............` <br /> SAN .JOAQUIN LOCAL HEAL DISTRICT_ <br /> u 13 24 , �n n­ �u �_ _ 7/72-3 M <br />