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—, . . <br /> FOR'OFFICE USEt APKICATION FOR SANITATION PERMIT 1. 77- <br /> ti Permit No. ............. <br /> ...... ............. .................. (complete In TrIplicate) <br /> ............ ........................................... Date issued <br /> I This Permit Expires I Year Prom Date Issued <br /> .................................... ................ <br /> permit. to sti%;d and Initall the work herein <br /> Application Is hereby made to 16 son I in-Local-Health District for a con <br /> lance with County Ordinance No. 549 and existing Rules and Regulations, <br /> 4 described. This application Is mo'de'ln compliance <br /> CENSUS TRACT .................... <br /> JOB ADDRESSAOCATION ......... C <br /> 4L ­wz/­ , <br /> �e <br /> Owner's Name ...... T I r�..... <br /> -1--71 �Y,tlohone <br /> T.. ...........6V6��_ I/ fi <br /> .. .. . ... ..... <br /> Address ................. S:*6.....7e ..... . ......................City ....... r <br /> ... ... . . ..... <br /> ..... ... <br /> .................................I cense n so # <br /> Contractor's Name <br /> installation will serve Residence 0'-Apartment Hou$�,(] Commercial 0TraIl&r_Coui02-_---- <br /> I I <br /> Motel EI-Other.......................•:.........I........... <br /> Grinder ...........*. Lot Size _ .... ........ <br /> Number of living units:......---... Number of-bedrooms ----------.-Garbage <br /> nome/�...it............................................. ...................t.........�.c.......t................Private C3 <br /> Water Supply: Public System andRN <br /> Character of soil to a depth of 3 feet: ;Sando SI1t(3 clayE3 Peato Sandy-Loam Clay Loam E3 i <br /> 140cipal❑ (Adobe[:) Fill Waterl'al ............If yes,type ............... ............ <br /> reverse.std <br /> (Plot plan, shawl09 size. of lot, locatio;Tf systern'In rotation to wells! buildings, 'etc. Must_,beplated. on. reve <br /> c� <br /> NEW INSTALLATION: (No septic tank or-seepiaWolt permitted if publ Ic sewer is available within 200jaet,) <br /> PACKAGE TREATMENT I SEPTIC TANK f )i Size.... ....... .. .. ............................ Liquid-TDopth ........... ....... <br /> • Capacity ------ Yi0e, <br /> ............. ............. Materlal....L................4 No., Compdrinienti ............... <br /> -We— <br /> DIstanc6 to 'e&eitl' !�T.............. ...............Foundation .............•--.....:Prop:LIM ... ........ ... <br /> Length ............................ <br /> LEACHING LINE No. of Lines .................1..... Length of such lice....:....4. t I I I W. <br /> 10* Box ............I -Type-filter.Material ...................Depth 'Filter.,Material I.....................:J............... <br /> noZ_............ <br /> Distance to nearest: Wall <br /> .......... .......... <br /> fiiud�ti -- .. ; 7 Pe6paity' 'Ll <br /> ................ on ... <br /> ❑ No <br /> - Depth ........ .......... Diameter .........:.�-...]Numler ............................ Rock Filled Yis <br /> SEEPAGE PIT I <br /> r .................... <br /> Water .................... ....... .Rock Sin......a-.Zy <br /> Distance to nearest:Wel!' ................ ...........Foundation-:.......... ......... Prop.-tine ..... ............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit. ........................ ..................... Date •-......•••.. .. ......--.........1. <br /> t14....... ....... <br /> L-* ... <br /> {Specify Roqylrementsl� .............e ........ Z_f...../ <br /> Septic Tank <br /> f ..... 111� <br /> Disposal FielciASpecify Reclulrem6ntsj /. .... . ..............; <br /> ................. ................ ...... ......... <br /> t. <br /> ........................... ...... ......................................... <br /> .... ................ .................. <br /> ...... ................................................. <br /> ................................................... <br /> . .................................. ........................................................... <br /> (br'6w' _4iist1n'g 'and required addition onieverse sidel <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 R-ulii-Cmd-26`9ulations of the San'Joaquin Local Health District. Home Owner or 1146W <br /> 17 sod agents signature certifies the foll;wing: <br /> -"Ich this permit is is.sued, I shall not employ any person In such manner <br /> W <br /> "I.certify that In the performance o6h L,wiia <br /> as to become subject to Workman's Compensation laws of Callfornia."I' <br /> .......... <br /> Signed . . .... . .... .............. ... ..... ..................... <br /> ............... ...... <br /> ........... <br /> .............................. yitle <br /> Owner <br /> ... ... ..4 <br /> By . ... ....... <br /> (If other than ed <br /> FOR 61E0ARYM1ENTAkSlE,,,, AY <br /> 'ON <br /> APPLICATION ACCEPTED BY ...... ............... ........... DATE ....17:R!A......... .......... <br /> .. ...... ......... .......DATE ............................................ <br /> BUILDING PERMIT ISSUED ............................................ . <br /> ............................ <br /> .............................1......................... ........ ...................._-.11.......... ..................... <br /> ADDITIONAL COMMENTS <br /> .................................... .......r...... ...... ............................................................................................. <br /> ...........­_1.........I................................................. .................. .............I...................... .......................................... ......I..................... <br /> .................................. .............. .................... ......... ................... ................................. <br /> .......................... 19P,-A..................... <br /> FinalInspection by. .................................................... ........................................... ate <br /> EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />