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rs,+R vr�a.e vacs <br /> APPLICATION FOR SANITATION PERMIT <br />......................................................... 74�— <br /> (Complete,in Triplicate! <br /> ...--...................••--••-•--•-•......_.. Permit Na. ..................... <br /> This Permit Expires 1 Year Frern Date Issued Date Issued .--1,5F:24 <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 compliant Ith County Ordinance No. 549 and existing Rules and Regulotionse <br /> JOB ADDRESSAOCA ION ,/ r(.-... I . .................................................CENSUS TRACT .......................... <br /> Owner's N e .......... ._ .....--- one .................................... <br /> ,(kddress d -------- <br /> ..- ....... <br /> Ci Ph...................... .... <br /> . - <br /> Gontrador's Name ..._._... - ----- - .... ................................license 71s��3 . Phoney ••_-•-- <br /> Installation will serves Residence partment House Commercial❑Trailer Court C 4 <br /> Motel ❑Other <br /> Number of living units:..... __-., Number of bed ooms .__'..-Gar a e Grinder .-....._.... lot Slate ... _. �a ............. '� <br /> LeL! ' <br /> Water Supply. Public System and name ••----. - ..� .._...._ ..............._._.............................._.................Private 0 <br /> Character of soil to a depth of 3 feet Sand E] Silt C] Clay Q Peat❑ Sandy Loam 0 Clay loam ❑ <br /> Hardpan ❑ Adobe Fill Mcterial ............ If yes,type............... ............ <br /> !Plot plan, showing sire 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 ...0............... Tyle .................... 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 .....'I...... Type Filter' Material ..:...............:.Depth Filter Material ........................................... <br /> Distance to(nearest, Well ........................ Foundation ........................ Property line ........................ <br /> I <br /> SEEPAGE� PIT Q I Depth Diameter ................ Number ............................ Rock Filled Yes C] -No Q <br /> Water Table DeOth ----•-••-•.......................................Rock Size ................................ <br /> Distance to nearest% Well ........Foundation .................... Prop. line <br /> • - ••.w...........•---- <br /> REPAIR/ADDITION[Prev. Sanitation Permit# •................................... ....... .Date .................................. <br /> Septic Tank (Specify Requirements) ......... .......: ..... •--••.......... .. ............. <br /> Dasssosai Field (Specify Requirements} - -•-....... ..... ,C}.`• --_-•-- --.._..-- <br /> .............................................. .......... ....................................................... <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, M accordance, with Son Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin tocol Health District. Home, owner or licen- <br /> sed agents signature certifies the following. <br /> "I certify lhrriNtha performance ofithe work for which this permit Is Issued, 1 shall not employ any person in such manner <br /> as to beeo{n/914a i o W n's rn e n laws of California." <br /> ...... ..... ... .... . .. .........i...... ........................... Owner <br /> By .......... .... . ......... // ,, ...............•--••-••.••........ <br /> _...lam!/.. .. -- ..-•-------••-•----...... Title .............. ..�............--••-- <br /> o er than ownerl <br /> i. FOR DEPARTMENT USE O Y <br /> y <br /> APPLICATION ACCEPTED BY .-.7'. _ DATE ...... . .... ............ <br /> '� <br /> BUILDING PERMIT ISSUED <br /> :............:.................... _.................................DATES-:...................... <br /> ADDITIONAL COMMENTS . ......I.......... ............................................. <br /> `.....----•.......................................................................... ...... .................................................. <br /> ....... .. <br /> FinalInspection by: .................... .. G ....-----....... ............Date .. .^.. _.. ,_.-: .------ <br /> FEH 13 2L 1-611 �v. 5?•l �- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1i 3M <br /> I <br />