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FOR OFFICE USE: <br />' APPLICATION FOR SANITATION PERMIT <br /> ................................... <br /> IComplete in Triplicate! Permit No. ..................... <br /> . ... ... <br /> -= 1.{F Date Issued <br /> „__-,,,•-•_-,,..-_-,-,••,..,.••••,.,,__......•....... This Permit Expires VYear 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 Counfiy Ordinance No, 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI N 7.7�. p.__.'.u! y'......I�@Z.ct'?'�'1. -+rr....i j. Gu�P. 1rNSUS TRACT ..............A....... <br /> .... <br /> ��.. .................:----------.......................................Phonee;� K-03.71............ <br /> Owner's Name ......... .... <br />' Address --7 � f ,, _-•�- COY <br /> f ........__:.........r 17 '.c.[/. !--- f3a?-s,1.'?� .4,4f--. city :•• <br /> 4 <br /> Contractor's Name " D's'r�--------- ------License # `�'.�p`f3... Phone .. :.-.. ..J60`1 <br /> Installation will serve: Residence XApa,,rtmgr t'House 0 Commercial [Trailer Court <br /> f Motel ❑Other ...... ........ -------- ------- <br /> Number of living units: ,....(.. .. Number of bedrooms ---2 -Garbage Grinder ............ Lot Size ..0.. .f ----------- <br /> Water Supply: Public System ond`name:: -------------------- Privatex <br /> Character of soil to a depth of 3`feet:4 Sand•❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> �" Hardpan ❑ Adobes(] Fi�I-Materialm e.. ...... If yes,type <br /> (Plot pian, showing size of lot, location <br /> gofisystern in relation to wells,-buildings, etc. must be placed on reverse side.).A. . <br /> NEW INSTALLATION: (No septic tankor"seepage pit perm tedi-if tpublie sewer is available within 200 feet,) . r <br /> r .L .� <br /> PACKAGE TREATMENT SEPTIC*TANK, Size.. . `___ . Liquid Depth -15 ...... ....... <br /> Capacrtyf 0 . _... Type .� ..._..._ all ateria1"[<lT r.-__-.- No. Compartments <br /> ..................... <br /> '"�� I .�,, 6...--- --Foundation ~``<*4" ..-.. Pro Line - _. <br /> + Distance to nearest-�Vlleli' � ` ._.-_ � p. �_.._----__ <br /> LEACHING LINE No. of Lines 5 <br /> � x .... ..... Length.of-each line ........ �............. Total Length ..2.D...__..._........... <br /> D' BOx..,#"""".Type FiIie—F7 0-ferial'14i --._.._Depth Filter Material ...f .-.•...............j._.._....... <br /> r 1 <br /> Distance to nearest: Well ...... �_.... __ Foundation .../D............... Property Line ­.>.................. <br /> SEEPAGE PIT [ Depth .. . ------ - Diameters X-/O... Number ............. .... Rock Filled Yes No {� <br /> Y� [►V S4 WateriTable Depth _.......................-•-•--- •.........Rock Size .......... r d <br /> i Distance to nearest: Well _.__ _ __f_ ________________Foundation .-/.4_............ Prop. Line ..7.____........::. <br /> FREPAIR/ADDITION(Prev. Sanitation Permi ---------- ------------- Date ------.-------------_--_---._..._-} �. <br /> I i14V­4<,.9, <br /> D� •�p �a0c?� <br /> Septic Tank (Specify Requirements) ... ..... lr�_G�,-. 1D049._1�. �-�Lttt��'+----.----..•---• �.-�� _- <br /> I i _.._ <br /> Disposal Field (Specify Requirements) .--•----•------------------ -------.--.-.-- ---.--- .--..._.. --._ _._. <br /> [ ------------- ---------------- .--- ------------- --------... ------. ........ ----- - --- -•_._........_......----- --._..... <br /> -------. - ... .................. ... . � _.----------------------------- <br /> ------------ .._.----- . <br /> (,Dl_dw-existing-and.required_acldition.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 Locirl Health District. }come owner or licen- <br /> sed agents signature certifies the-following: - <br /> I "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 Com0614ation laws of California." <br /> Signed .... . ................. .... .. <br /> Owner <br /> By <br /> Title . ...c%`l ' <br /> Lig . ................................. . . . <br /> {If r than owner) { <br /> "FORDEPA <br /> MENT USE ONLY APPLICATION ACCEPTED BY .-.. DATE j:�./.. ..%.-7.. __._... <br /> BUILDING PERMIT ISSUED . DATE .._ ? - <br /> ADDITIONAL COMMENTS ------ -- -- •............ .•--•........--------.._._._.-........._.. #........ - <br /> t ----------------------------------------- ---------..---.-...._..----..._......._---...---.-• <br /> 1� .... <br /> i -------------------------------- E ---------•----..-....:......... <br /> Final Inspection by: ----..../-<! / �.. t.} .. Date .... ......._..3....-... <br /> ...... ......... <br /> SAN JOAQU LOCAL HEALTH DISTRICT <br /> 0 <br /> e u 13 24 1 .4e fl- ru 71723 ,11 <br />