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- AOR OFFICE USE: <br /> APPLICATION'FORrSANITATION -PERMIT <br /> I = i Permit No: -- <br /> (Complete iA Triplicate) <br /> k ---------- --------= <br /> Date Issued --- <br /> ---------- <br /> This Permit Expires 1 Year From'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 is made in compliance with County.Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ._l3-_�3.2._'�--_!" _3_Y_"N C. �' ' = CENSUS TRACT -------------------------- <br /> r 1 - -------------------Phone -- -----------------------------•--- <br /> Owner's.Name ___P _ -- <br /> Address I 3 ------ It .�f- "'�------ -------------- <br /> --. City l �'"� o <br /> Contractor's Name ®Qv1. s5e�r�cTi+>✓1C S�ruiC --f,D�_CArTLicense # . �"._�_�_7-�?---;Phone _ _�_Zy----- --- <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court; i❑ <br /> Motel ❑ Other __�ysf'"-- ___" Grinder _____-____._ Lot Size lQS; 9'�_X__f "�_� <br /> �` <br /> Number.of living units:---- Number of bedrooms -- ------ i <br /> Water Supply: Public System and name --------------------------------------------------------- <br /> 'ClY Private [ <br /> Character of soil to a depth of 3 feet: Sand'❑ SiltClay ❑ Peat❑ Sandy Loam Clay Loan [] <br /> Hardpan ❑ Adobe E] Fill Material ------------ If yes,type ------- --------------------: <br /> {Plot plan, 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 /> SEPTIC TANK' Size� �x�d� , _------ Li uid Depth <br /> PACKAGE TREATMENT [ ] [� <br /> � q � P __.--�.-�, :-•� - ---rte <br /> -------------- <br /> Capacity JQ� Type -Pr _ r_ Tr No.'1kCompartments ____'._=....__. <br /> ! Distance to nearest: Well --------------S�Q '_____._-______Foundation -----!o------------ Prop. Line -----s__-------•----1 1 <br /> 1.3 . <br /> 3 <br /> LEACHING LINE [ No. of Lines ----- ---- ------------ Length of each line------ -------- Total Length —3 ------------- <br /> cc�� c.�� <br /> i f 'D' Box :y�_S_._ Type Filter Material C.LC.....Depth Filter Material "".1 "_------------------------------•- <br /> ' Distance to nearest: Well ------------ Foundation `-- --- - Property Line, __s------------------- <br /> SEEPAGE PIT #[ ) Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C3 <br /> r <br /> Rock Size =---- --- <br /> Water Table Depth -___________ W <br /> -------------=--- --------- _______ <br /> Distance to nearest: Well ----------- -----------------------------Foundation --------k- `---- Prop. Line ----------------_---- <br /> - [ , � Date -------------------------`.------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- <br /> Septic <br /> ._.'------_ <br /> Se tic Tank Specif ;R�quirements)..----------- ----- - - ------- ----- - ----- -- <br /> ) <br /> � <br /> Disposal Field (Specify Requirements) -----------_ , <br /> ------------------------------------------------------------------------- <br /> ------------------------' -------------------------------------------------------------------- ----------------------------- ----------------------------------------- ----- --------------------------------------- <br /> -- - --------------------------------- -------------------------------------------- <br /> i _ - _ <br /> (Draw existing and required addition on reverse-'side)e)-^� <br /> 4 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 /> t <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 subiect to rkman's Compensation laws of California." <br /> np-�'-� " �aTi -rd` -k $ r v-1 cC--------- Owner - <br /> s- - ,k <br /> ----------------------- <br /> By <br /> --- Title ----------- <br /> (If other than,owner) 3 ' <br /> t - FOR-DEPARTMENT 'USE.ONLY <br /> - <br /> APPLICATION ACCEPTED BY - ---------- --------------`--------------------------------------. DATE _ - _` '7 4/ <br /> BUILDING PERMIT ISSUED -------------------------------------- -------------------------- _ =--------------DATE -------------•----------------- ----------- <br /> . <br /> --= - "-- � * - ------------- <br /> ADDITIONAL COMMENTS ----------------- -- - --------------- ---------------- ------------- -- <br /> - 1 <br /> �. <br /> -------------------- <br /> x <br /> -- <br /> ----------- <br /> ------ --------------------------- <br /> ------------- <br /> - <br /> -t ----------------------- ---- ------------ - - _ <br /> Date <br /> Final Inspection by-- __--- - -- <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />