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FOR OFFICE USE: APPLICATION FOR SANITATION <br /> PERMIT <br /> - ---. <br /> .. .... ............................ Permit No. J 2- <br /> (Complete in Triplicate) <br />'....................... ..................... . .. 6 . 2S - 7S". <br /> ............... This Permit Expires I Year From Date Issued Doti-Issved .................... <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 1 made in compliance w' h County Ord�" nce No. 549 and existing Rules and Regulations. <br /> E <br /> 1 . . �}�r_n�PO <br /> .2Yt v-t- � --rC �T T <br /> JOB ADDRESS/LOCATION I/V�2NC1Z_DG... ..G_...1-C'i ....E/5� �.- .---- CENSUS TRACT ....--••.............:.... <br /> Owner's Name ..:................. 1f .Es'®IV....... ------In... Phone !W' .gd._21-- <br /> Address . .. .. - .. ._._... ... .- - �--------•--- City ._. -- y--- --- -s <br /> Contractor's Namet z'-' ..---R,p_(2Is.K--- S.,7LS'._..L Alm...-.License# . ...... .............. Phone .--- <br /> Installation will serve: Residence KApartment House 0 Commercial []Trailer Court ;❑ <br /> Motel ❑Other .......... . ---­----------­----­-- <br /> Number <br /> ------------- ----- -Number of living units:.......... . Number of bedroom-_---Garbage Grinder .._....,.... Lot Size ��'` .. ' .......... <br /> E Water Supply: Public System and name .... ....................... ........... ...------------- __..Privat5 <br /> Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpa Adobe ❑ Fill Material ...... _:__. If yes,type ............................ <br /> k (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 /> Liquid ..._. _.., <br /> PACKAGE TREATMENT ( ] SEPTIC ANK�' Size._� �_....._..-�:.-....___... De th p .-. • <br /> Capacity,!{ 0.0 . . Type~L . .- Material&.7tC° _ No.r,Compartments .... . .......', <br /> Distance to nearest: Well ........... ....Foundation .,f ........... Prop. Line .` ._.__. <br /> LEACHING LINE ( No. of Lines - - Length f each ine . . .`;... Total Length .....�.�r_®.�..._.. <br /> D Sox .. Type Filter Mater�al�__..j___Depth Filter Material ..1 _p ..............-------.......{p <br /> I U <br /> Distance to nearest: Well _1.�. Foundation 7..�...... Property Line <br /> SEEPAGE PIT Depth-r_.... Diameter .._ Number Rock Filled Yes, No Cp`' <br /> Rock Size _..._ .. <br /> ` Water Table Depth ... `f "'---.a__'_...- ___-.. � ... --y------ <br /> Distance to nearest: Well --------------Foundation Prop. Line .._ Q.d.....[.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ............. ................ Date --------- -----_---------__1 <br /> Septic Tank (Specify Requirements) . ...:.............. ..... -----......._.....-- ;-- -- ------= ---- ................. ... ...... <br /> Disposal Field (Specify Requirements) <br /> ...................... ......_ ............... -- ----- <br /> A <br /> I <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 in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HRalth 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, I shall not employ any person in such manner <br /> as to b OTB subject o man's Compens ' ws of California." <br /> Signed ..---_ <br /> By . . ................. L .. ..,.... Title ............... ... <br /> (If other than owner) <br /> 1 FOR DEPARTMENT USE ONLY <br /> P APPLICATION ACCEPTED BY ... .. .... . .. .. ................... .......... . DATE 67 <br /> BUILDING PERMIT ISSUED ..... ......../ DATE _ ............. ..................... <br /> ADDITIONAL COMMENTS ....7/.I Aj.. __. dfa C _ Gh.... ... .--... ... I.. ........... -----_ <br /> - ------------ - -- -----------­­ ........-..- ---- ------------•------ •...._.. ....................... <br /> ----- --------------------------------------------------- ----------------------- .._...1--._...--....------•-- ........ <br /> ._........................... <br /> ...------------- ------ ---------------- <br /> ....................................... �,� --.-......--- --------- _---�-------------- <br /> Final Inspection by: - Ge-..,-------- -------- ------- -----------------' •--- ---.._..----....-- Date _..7._ .l-4-. ..ZS..........------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7172 3 )4 <br />