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FOR OFFICE USE- <br /> APPLICATION FOR SANITATION PERMIT <br /> k )0 6h,Y" - ( � — -� (Complete in Triplicate) Permit No. ..................... <br /> .... .. <br /> -, <br /> .�.............. ... ���f This Permit Expires 1 Year From Date issued Date issued ..1. ./0.-,7s <br /> ... <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 Regulationsc <br /> JOB ADDRESS/LOCATION .............3.6 5..,..Azl t.eras...................... ......... .....CENSUS TRACT ................ <br /> Owner's Name Tony Bus an Phone <br /> .. . . ............................................ ..................................... <br /> Address ---- _.,.---36---5:-.-Arj:ter-os..............................City <br /> Contractor's Name ..................Roto-• Q.Qter_.aewer_-.S.er........._.....License #2. .1. Phone 465_-.261.6 <br /> Installation will serve: Residence Q Apartment House Q Commercial QTrailer Court Q <br /> MotelQ Other..---------•---••--........._•.............. <br /> Number of living units:...... Number of bedrooms __4_.__.._Garbage Grinder Ye S_--.. Lot Size ...75.-_x200 1 <br /> .----•-_•.......... <br /> Calif'. Water and private well <br /> Water Supply: Public System and name ............. .....................Private Q <br /> Character of soil to a depth of 3 feet: Sand Q Silt Q Clay Q Peat Q Sandy Loam Q Clay Loam D <br /> Hardpan 0 Adobe fl Fill Material?�9....... if yes,type............... ............ <br /> (Plot pian, 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 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size------------------------•-_---_--__ ------ Liquid Depth ...................... <br /> Capacity - ..__ Type -------------------- Material---- --------- No. Compartments <br /> Distance to nearest: Well ---- ._-- •----------------Foundation ---_--------__--- Prop. Line .................... <br /> LEACHING LINE { ] No. of Lines ........................ Length of each line. .. ................................ Total length ............................ <br /> 'D' Box ....._..._ Type Filter Material ................... Depth Filter Mgteria) ...........--%A <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT { j Depth .................... Diameter ................ Number .................. <br /> .—.� .......--- Rock Filled Yes Q No <br /> Water Table Depth ................................................Rock Size ............. .................. <br /> Distance to nearest: Well ........................................Fov#sdation Prop. line .._.. - - ....1 <br /> REPAIR/ADDITION(Prev. Sag1tation Permit# .....-..._...:.. O <br /> -----•-••----_----- Date .-.... ...•.............••----) IA <br /> SepticTank (Specify Requ#rements) ............................................................._............................,.....................,..........._.......,......... <br /> Disposal Field (Specify Requirements) ---------------add.. .0.1--_-1-e-aah---and...1-3- -wF---b <br /> � y..25.a....pit----�o....................... <br /> . ........_..�xi ti sYs.teM-•--------•-------••---------- •---------• ----------------- <br /> � <br /> ...................................................... ...... -----------------------------------------------..................................................... <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 lice* <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 ------------- ---------- --------------_----JQ_e...WJ i-te....... .......................... Title .Contr.ac.tQr-----....... <br /> .. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED — � GFX •--- .. �.:, - -----------............... DATE ..Z /C/ .T._'2----------- <br /> BUILDING PERMIT ISSUED----------- ............................ -------.DATE . ..................................... <br /> ADDITIONAL COMMENTS - ...................... ,._...._.._.... ..........._.... <br /> ............------------- -----------------•----------------- -------------- ..... • _.._....-....-......-.....:-.................I...... ........................ <br /> . <br /> /Final Inspection by: •-----•-; . . . - Date .,./ �--- ----------- <br /> EH 13 2h 1-6 �V. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M <br />