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FOR OFFICE USE: <br /> APPLICATION POR ,$ANITATION PERMIT <br /> '' Permit No. __ � 3 3,F <br /> �� {Complete in Triplicate) ___. <br /> -- -- ---------`` <br /> ______ This Permit Expires 3 Year From Date Issued 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--��_---G_-------S---- '1 -- .....� 1------�'---C, p------CENSUS TRACT -------------------------- <br /> Owner's Narne --------- s'! f <br /> ----- -- -- <br /> Phone <br /> Address ---------- - � a 1-/,-0-D'I? - ------ cb " CitY� - fr-�t-V►��-co <br /> ------ <br /> Contractor's Name _-G= --II I_E' �Y---- ---- -/'--------------- ----- 7'. License# &�-� F( Phone�•�3---- se/ <br /> Installation will serve: Residence W Apartment House,❑ Comercial ❑Trailer Court ;❑ <br /> Motel ❑Other ----------------------------/- <br /> Number of living units:---'j/----- N6rriber•of-'bedrooms _____'�J�_""_G—rrbageTG�inder-�'' 3__--'Lot Size __ __ c__� _�' <br /> -- <br /> Water Supply: Public System and name ---------------------------------•---------- --------------------------------------------------------------Private ❑ <br /> k Character of soil to a depth�of 3 feet: Sand'® Silt❑ Clay ❑� Peat❑ Sandy ram ❑ Clay Loam ❑ <br />[� Hardpan ❑ Adobe'❑ Fill Material ------------- <br /> if yes;type ---------------------------- <br /> � - <br /> (Plotsplan, showing size of lot, location of system in relation to-'wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION- ` SNo es p is tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT. <br /> - f l; SEPTIC TANK[ �---` -------------- i------ Liquid Depth ��- ....----------- <br /> Capacity <br /> ---- -- - <br /> Capacity IWod_------- Type p>`�_ ����Material___��'^`C`__-- i No. Compartments --- ----------­--- <br /> w <br /> Distance to nearest: Well------_IF 3_--_-__________Foundation .____ ----------- Prop. Line.-.- d.___._.___ <br /> 11' <br /> LEACHING LINE [ ] No. of Lines '-_-__ -- Length of each line._.- �- Total Length <br /> � ' <br /> - � ,� �. <br /> I 'D;' Box __-.�______ Type Filter Material//Z Filter Material ______ .._ <br /> } zT <br /> .-- to-to-neare�t:Well __-_1�`f�_`._foundation- --------------_____-_.-Property-.Line--_'- <br /> ---------------- <br /> SEEPAGE PIT [ ) Depth - _____A_ Diameter __-___I--_ -- Number ---------------------------. Rock Filled'` Yes ❑ .No 1❑ <br /> r Water Table Depth ------------ ----------1'"------------ -------Rock Size -------------------------------- ! 0 <br /> ° IM ; <br /> Distance to nearest!.-Vdell _:: "� - --- ------------- ---•-•--.Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION <br /> ----.------REPAIR/ADDITION(Prev. Scfnitation Permit# _-._.: - __ _________________ Date ____ ` <br /> Ip ---------- -----) <br /> Septic Tank (Specify RegLiremer{fs`)I_ �--------__________ ----� <br /> ----------------- <br /> Disposal Field (Speafy ;;.equirements) --------------`tl---�---•---:--------------- �� Y � <br /> ---- - '7----------- I� ' ------- ----------------------------- <br /> -------------- <br /> .- <br /> ------------------ <br /> ----------------------------- <br /> --------------------- <br /> ----------------------- <br /> .f :I� zea - '` -! �s -- -- <br /> __�_ J -ate , <br /> ..� (Draw existing and required addition on reverse side) �, <br /> I hereby certify that I nave prepared this-application and thatw <br /> the work ill be -done in accordance with San Joaquin <br /> County Ordinances, State Daws, and pules a' d Regulations a,f the San Joaquin Local Health District. Home owner or licen- <br /> sed a encs signature certifidi the following: <br /> "I certify that in the perforAunce of.the work for which this permit is issued,.I shall not employ any person in such manner <br /> as to become sub!ect to Workman's.Compensation laws-of_California." <br /> Signed /7' fl S�.v - Owner i <br /> r ' <br /> ------------------------------------ <br /> BY ^ ------ Title f , <br /> -�` (If other .i, <br /> 11 1---------------------- <br /> FAR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> �/!l- - ------ ---- ------------------ ------ ---- -- - ----------------------- DATE -----�:-`/-�'f__-�--7�---- --- <br /> BUILDING PERMIT ISSUED k --------------- ---•--------- ---------------------------------DATE -----------E <br /> ADDITIONAL COMMENTS - ----------- - <br /> ------------- --------------------------------------------------------------------------------------- <br /> ----------------------------------1------------------ <br /> ------- ------- <br /> 1---------------- -- ------- ---- ------------------ - ------ <br /> -------- ---------------------------------- ------- <br /> Final Inspection by. _ -- ----- [{ <br /> f -- ----- ----Date ! ------- ------- <br /> I! SAN JOAQUIN_LOCALHgALTH_R1 5TRICT <br /> E. H. 9. I '6$ Rev. 5M I � �', Z.. <br /> C.!+,� <br /> I� <br />