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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. ...7?."3`/� <br /> —(Complete in Triplicate) _ <br /> '............................................. -•--••-- <br /> `�;'"�- . �. t9is issued .5..`�/—��. <br /> ........................................................ . This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son 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. 544 and existing Rules and Regulations: <br /> r <br /> JOB ADDRESS/LOCATION <br /> . .�. D9 � ...._... . . . �.� .. - �� S TRACT <br /> ...... <br /> r's Nam . ...... .._� - ... ...................Phone Y7c�_``906__:...._..Owne ' {Address ......................13.2) -- -- ---•:.. City .......... ....---,............................. <br /> .- ... Phone 41Kp.4P7Contractor's Name ........ ............................License ..... <br /> Installation will serve: Residence E]Apartment House f] Commercial ❑Troller Court 0 <br /> Motel ❑Other t <br /> Number of living units ..... Number of bedrooms -.3-..."Garbage Grinder ...... ._ .. LotnSize ... ................. <br /> Water Supply: Public System and name ...................................`•----------•------ .._........-----.� 1 -�-.....--.........Private ❑ <br /> Character of soil to a depth of 3 feet: Sande Silt© • Clay ❑ Peat'❑ Sandy LoomM Clay Loam.M <br /> Hardpori❑ Ado'be'❑ Fill Material .. : :.... If yes,type .................___........ <br /> I <br /> (Plot plan, showing size of lot, location of._system in relation to.wells, buildings, etc. must be placed on reverse side.) <br /> u=.� > <br /> NEW INSTALLATION: (No septic tank. or seepage pit permitted if public sewer is available within200 feet,) 0 0 <br /> PACKAGE TREATMENT ( ] SEPTIC TANK iI . Liquid Depth ............... <br /> Capacity Type . � � <br /> ........... Material.. d .-. No. Compaments _.•:_•__. ... -.. <br /> .._ v, <br /> Distance to nearest: Well .:..................................Foundation ld_........... Prop. Line cam " <br /> LEACHING LINE No. of Lines .....................:.. Length of each line.._-.�5..._..-•_._..: Total Length ....170­1 N <br /> ee -- <br /> 'D' Box ------------ Type Filter'Material _1� .___.Depth Filter Material .__...._.../<f....r...............:... <br /> Distance to nearest: Well ...._... !_. �... Foundation .....`. ............ Property Line o <br /> Diameter Number .......... ........... Rock Filled Yes Na <br /> i <br /> �. >, 0 <br /> Dept •^ -- <br /> f �• it <br /> Water Table Depth _ ... Rock Size/ _11.J4�..�-_-. <br /> Distance to nearest: Well .../ " Prop. Line ..�........ <br /> _.........-�----••-•--•--...._..... Foundation ..-• ----- � ...__.. � <br /> R L <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> ................ - ------- --- Date - ----• <br /> Septic Tank (Specify Requirements) N o <br /> Disposal Field (Specify Requirements) ...................... ............................................................................................I---------------- <br /> .... . ..... ... <br /> ........................... ..................................•-.•.-- <br /> .... ....... .... •-••••------•-•••--- �--ti;-•....-----•-----• ----- ....----.......... <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 Joaquin Local health District. Home owner or licen- <br /> sed agents signature certifies the following: w---- <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 laias of California." <br /> Signed _...-...... - ----- -------- ---------------------- <br /> -------- Owner <br /> By ................ . ..._•... ................... Ti I, t e ---- Eca ...........:._.............................. <br /> ... <br /> (If other t a owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... . ..:.... __. .......... DATE ...._... ..1�.-_-- - ............ <br /> BUILDING PERMIT ISSUED ............ <br /> :....... .............. ----------------- --------- <br /> ADDITIONALCOMMENTS ....__--_-----••--_--- -•:.............:......-------•--------.-•-•--•-•----••------••......--•---•-•-----............--•..._.:...._...._.........._.._... <br /> Final Inspection by: _.. •-.. �!l/j?? -:'�r 'a 3 Date .--.. .'" ... _ . <br /> —SAN JOAQUIN LOCAL HEALTH DISTRICT � � _ _ - <br /> i <br /> E. H.13 241-'68 Rev. 5M 7/72 3 M_ <br />