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FOR OFFICE.USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> �:.... .._... 3� :f: <br /> (Complete in Triplicate) Permit No. <br /> IV, Ir <br /> �I Date Issued <br /> ....._...... This Permit Expires Y Year From Date isiue"d •• •••• <br /> / � 2 <br /> 7 -W—nom <br /> Application is hereby made to the San Joaquin Local Wealth District for a permit to constr ct ii d install the work herein <br /> described. This application is; <br /> Imade,in compliance with County Ordinance No. 544 and existing Rules and Regulations. <br /> JOB ADDRESS LOC i0 �f- l_ 7 <br /> C-4.� <br /> " SUS TRACT <br /> Owner's Nome ...... _...._.. h .... . <br /> Address <br /> l `.. -------------- City .... <br /> Contractor's Name .. .............."..... .... ---...License #, f_� .... Phone .. f°b..�fr� { . ,• <br /> Insto_Ilotion.will serve: Residence Apartment House Commercial ❑Trailer Court 0 � <br /> ' I <br /> Motel ❑Other ...._- ...... •----- / <br /> r <br /> Number of living units:.... Numbeof-bedrooms Garbage-Grind <br /> �� <br /> er . .-- Cot`Size -5 <br /> Water Supply. Public System and name .................. � k� <br /> -.Private ❑ l <br /> Character of soil to b depth of 3 feet: Sand E] Silt ElClay E] Peat E] Sandy loam Clay LbomA 4 <br /> Hardpan ❑ '*Adobe . Fill Material If yes, type ...... f <br /> ".- .•.`--- �., y -he.1.3YT. \�� �p`` y i —('tel <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc: must be placed on reverse <br /> NEW INSTALLATION: I) <br /> [ ] SIII <br /> EPTIC TANK public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT P P permitted ize-. - �' <br /> o se tic tan or seepage it �if�'--�--�.. -•----------•--- ""-- Liquid Depth .��...............:.{ <br /> Caps ity O TYp ' Material..cr i>' .�... N o�npartments .... <br /> Distances:td.�nearest: Well .----._Foundation �,�__..._ ... Prop Line . <br /> fff � ' <br /> i �.. ... . l _ _. ...... <br /> -- Length of each line ....:. r ... L' <br /> �, <br /> LEACHING LINE � No. {o'�k Lines _ g �" .... ���tTotal Lengt"h=�`. ./._?�................ <br /> 'D' Box ��Type',Filter'Material_: ...-.Depth_FiIter_Mater.icfl l_�. <br /> . . ............................. <br /> ..... ..... .. <br /> Distance to nearest: Well ------------------------ Foundation ......... ProperLine ry' <br /> SEEPAGE PIT Depths ,'. jS Diameter ----I......... Numbe ...... Rock Filled Yes No [] <br /> kY <br /> l .�-. � "l �r �{ ��r � <br /> Water Table Depth ___---------- ---------------------------------Rock Si e l . I <br /> Distance to nearest: Well --------- --------"-......_...._....._•.Foundation _60._.'It-...... Prop. Line __- ...t........ <br /> �r _ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............. ........... ."-- ............ Date ................. —1 <br /> Septic Tank {Specify Require. ents) f <br /> ---------- ------• ................................. .................. ....................... I <br /> Disposal Field (Specify Requirements) - -- ----------------------------------------- <br /> -- -- ------------- ...--- ------ -----.._....---...._.......4. . -----......_.._.. . .----.....----------........ <br /> .. .....-.. "-. .__....... <br /> # . 4Draw <br /> existing and require. ------ ---------- ..-----....... <br /> ddition on reverse side) <br /> I hereby certify that I ha_ve_prep.ared,thi1 application and that the work will be done in iaccordonce with San Joaquin <br /> County Ordinances, State Laws and Rules.and Regulations of the San Joaquin local Health!District. Horne 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 Workman's Compensation laws of California." ' <br /> Signed --- Owner <br /> By ( Title . ... . ........... <br /> I oth han owner) <br /> FOS DI:IpARTMENT USE rONLY <br /> . . .. <br /> APPLICATION ACCEPTED BY ...;, ... ..� DATE -- .,,. . ..]..,s`.. , <br /> BUILDING PERMIT ISSUED ...... ......... . .. ..... <br /> . ............ ....... -"......DATE ..._.... ........... ------- <br /> ADDITIONAL COMMENTS ... ,._. _... <br /> ..._.!� ` <br /> - <br /> ............... ....._..__.._... ..-......... _ .- - _.. -.... <br /> Final Inspection by: ..-J Date ,. ... ... <br /> -7 -7. <br /> SAN OAQUIN LOCAL WEALTH DISTRICT <br /> . <br /> E. H. 13 24 4 <br />