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FOR OFFICE USE:' <br /> APPLICATION. FOR SANITATION PERMIT <br /> ......................:...:.__::....:- - <br /> 5� <br /> Pemnit No. ..75... <br /> lComplete In Triplicate) .. . ... _._... . .,, r..., - <br /> ...................................................•-..._ This Permit Expires 1 Year From Dot*Issued <br /> 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 i In mp�iance with County Ordinance No. 549 and existirt8 Rules and IZegufations:OJOB ADDRESS/LOCATION ��acle <br /> ��__.�.. ��� 1Q�.:_...............................� � ���N a ..... <br /> f ...__--.-Cl: S TRACT .............. <br /> Owner's NameJ <br /> .................................•------•-•--• •. __-_ . �._..........Phone __ -- _•-- _. <br /> Address .. ..............city ...... <br /> 05;7............................................ <br /> I <br /> Contractor's Name f ' _ !1K31 ! 1�'^ ---------•L€cense ` aJ7 � __ Phone . = 3: <br /> Installation will serve: Residence 0 Apartment House 0 Commercial OTraller Court 0 <br /> ° Motel ❑Other ....... ....... �?� <br /> Number of living units:...........: Number of bedrooms :.....Garbage Grinder ........... Lot Size :.... <br /> -._ <br /> Water Supply: <br /> Public-Systemand name .................................... ............._. ...._________.___....__. ..._........Private-,�� <br /> e� m< ._ <br /> Gharacilerof spil to'a depth of 3 feet: Sand SiltCla Peat San LoarnCla iocm `•` ' ` <br /> Hardpan❑ Adobe❑ . FIII'Mater€al ..._........ If yes,type............... ............ <br /> " i <br /> - <br /> .. (Plot plan, snowing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: IN o s is tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> 3 7© .( _.w ..............`Liquid Depth ...._...... <br /> `- <br /> PACKAGE TREATMENT SEPTIC TANK Size-- -_--_-- -. 11 __.. 0 r <br /> Capacity f�QQ� ___-- Typ aterial.. ............. ... a.� Compartments ............../ <br /> _.. ........ ... <br /> Distance.to nearest: Well ....._J'__ f_.r?`� �c . <br /> ... -------•--.Foundation . Prop. Line .... .. ... <br /> LEACHING LINE No. of Lines ..... ..... Length of each Eine_. ., r .._. Total Length -. :f•..--..---• <br /> 'D' Box . _ Type Filter Mat dial 1lf-�lA1,;..Depth .Filter�Material r <br /> . Foundation . Property Line ... ....__.. <br /> Distance to nearest; Well _- '-........_. _.__._.,:__. <br /> SEEPAGE PIT t ] Depth .................... Diameter ­.:.............. Number,............................ Rock Filled Yes ❑ No 3: ; <br /> sWater Table Depth ................................................Rock Size ................ -••---•... ---- <br /> 'Distance to nearest: Well ____-_--foundation _: Prop. Line <br /> v REPAIR/ADDITION(Prev. Sanitation Permit ....................... Date ... ..:......... <br /> Septic Tank (Specify Requirements) -------•-------- -----------------•---- ...__.................•--_..... ._._�_.:.. ,..,...................... <br /> Disposal Field (Specify Requirements) ._A................................................................. <br /> «, {Draw existing and required addition on reverse side) g <br /> , 1.herebkyjcehlfy;that.I Aav prepared this application •End.that the twortC will bai done in.;accordpfi"clr.with Son ?oaqtiin <br /> > ., . ..- <br /> Cour►ijr_O►dinances, State Lcmis;--and Rules and Regulations of the fan Joaquin Local Heci�th DIOrlet. Home owner or licin. <br /> sed agents signature certifies the following: r` <br /> "I certify that In the performance of the wetk,.,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 Californla." <br /> Signed Owner 01 <br /> SY -------------- -- "`r ------- Title _421111C-- ��-"" .................... <br /> llf other than owner! <br /> FOR DEPARTMENT USE ONLY � <br /> APPLICATION .ACCEPTED BY _.-- Y <br /> -- ---- ----............................ ----•- --• DATE_T- 7 <br /> BUILDING PERMIT ISSUED .......:..... .-- •--------•-•••--.:_...-•-•..--•' ...... ----------`-_DATE ------ ---•-------------..._.....:_.. F: <br /> ADDITIONALCOMMENTS -------------------- ........-.........-...............-...........................------- -----•-.._......-----•------------------- ---------••..---. ......... ` <br /> _______________---------------_____________ __....________. ._._......-___________-_..._____.._-_._____.--_______-._..___-________. <br /> Y _ ..`.. <br /> ___________________________...__. __. _ ............_........ <br /> Final Inspection by: <br /> Dote <br /> EH 13 24 1-6$ It,,. .'' y SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M t. <br />