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rUK c�rri�t use: APPLICATION FOR SANITATION PERMIT <br /> ., -. Permit No.- ` <br /> {Complete in Triplicate); <br /> This Permit Expires 2 las r From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Hoolth b-istii'ct 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 ADDRi s/Loc ]ON __}n �-._.., 5..._.._ ..m + �2. I�NSUS TRACE ............... . ....... <br /> Owner's Name ...... rl - �! r � ....Phone' .t!�.. <br /> ........C; '4..................... ?..-... <br /> ..... <br /> Address .��` ,../ t --------------------- <br /> D <br /> �.... City <br /> Contractor's Name -____- -- _F.c1l9- _tw__. 'e . .± �1 +P --._.License #257—At . Phone ...�.-`�';�'-/.i�_ <br /> Installation will serve: Residence ]Apartment.House fl Commercial Trailer Court <br /> Motel.❑Otherl, .l�1bc-.t1a ���_ PSL-v �L�� �d7�GUrlts . <br /> Number of living units:---AIX_ Number of bedrooms __A _.-__Garbage'.Grinder ./t//, Lot Size <br /> Water Supply: Public System and name Private <br /> Character of soil to a depth of 3 feet:. SandA Silt❑ ' Clay:Xj� Peat❑ Sandy Loam 0 Clay Loam ❑ # <br /> Hardpan Q Adobe 0 Fill M6terlal ------------ If yes,type............... ............ <br /> {Plot pion, 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 /> • <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f' Size.................r._. --...... -------------- Liquid Depth ..__......_....._ ....... <br /> 'Capacity ------------------•- Type ---------•--_i.... Material-.�------------------ No. CornpartmeAts .......-.............. <br /> �'bistance to nearest: Well ______ __ <br /> ---------- ..........Foundation`---------------------- Prop. Line ------------`=---....... <br /> LEACHING LINE [ J No. of Lines ---------------------_. Length of each line.-_`---------- ...... Total Length ............................. <br /> 'D',Box ............ Type Filter Material ....................Depth filter Material _.........._._._....:...._......_ <br /> ....... <br /> .... <br /> Distance to nearest: Well --------------".-:. _... Foundation -----....__._......_.... Property Line n-_....... .. <br /> :..... .... <br /> SEEPAGE PIT ( } Depth -----._.:.ti........ Diameter .........:...... Number y----------__-- Rock Filled Yes ❑"'No <br /> Water Table Depth.----•-------------------_- ---------__---Rock Size -_•=-•----•.--.....------------- <br /> Distance to nearest: Well .---:.._.. - ­--------_----Folundatio n ----------- ----- Prop: Line ....:_.... ........... <br /> ' <br /> REPAIR/ADDITION <br /> Tank (SpecifyN Pe Renu cements ermi� ......________________________f_.._..__-_-. Date ---------------- <br /> Septic <br /> ___-- � ) <br /> ---�---- <br /> Disposal Field (Specify Requirements) -+9D .. <br /> ------------- -- � <br /> ----------------------------------------- - ` <br /> - <br /> m ---•-� ----- ------•------------ ---••--• ---------"-'-•••--._..-. <br /> (Draw existing and iequired 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 licen. <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is Issued, 1.shall not employ any person in such manner <br /> as to become suble t to Workman's Comp nsation laws of California." <br /> Signed ---• . . . .......... --.� m:. ---- --•-�. Owner <br /> - •--- <br /> BY : (If othet�han--------------------------------------------------- ------------- Title _..__ ..1.__..._-._. <br /> owner <br /> FOR DEPARTMENT USE 6,NLY � <br /> APPLICATION ACCEPTED BY / l:7 r� ¢ <br /> 1.�O�-Q✓ airr,�/c 2r�7.�f/YY- , �_.t-.r-s-- t6r1b.--r..�_.. , �--�•- r-� <br /> .c..,r..�..._,.�DATE...:. <br /> ft,�1�=C.t <br /> ........... <br /> -�-- --_7--.BUILDING PERMIT ISSUEDDA 7 <br /> fDD TIQNAL COMMENTS � --------- �...-.._-..- <br /> ._ 1 -� --.----G <br /> ' <br /> ------------------- <br /> ,ire ..fPjcu.�s. .r.•.r . �.:'�61� ..�........ .............. ................... <br /> - - w..�`. o._.:�..�Z.L�.�.,�.�rr��x� •- <br /> Final Inspection b w _ --�'p-- � � '��---•--.- <br /> p Y . ...__.._.Qate �/ <br /> 13 2h 1� v• SAN JOAQUIN LOCAL HEALTH DISTRICT- 8/7h 3M <br />