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FOR OFFICE USE; <br /> APPLICATION FOR SANITATION PERMIT <br /> ;......_........................................�........ <br /> (Complete in Triplicate) Permit No. ................... <br /> Dote Issued -_. <br /> •.......• •-.... .. ........_ This Permit Expires 1 Year From Date Issued <br /> 9—/ .•7S' <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 anng Rules and Regulotions: <br /> JOB ADDRESS LOC ION` AV.. ­... L �l._ _. Y` <br /> ,a _,.. _ CEN .............. <br /> Owner's Nome.......� .t::. ._ ? %...�` ' ......:.:.......... <br /> ..............................� _.Pltone ...__:.... <br /> - SUS TRACY <br /> a___- <br /> • 9 t <br /> Address 18' .2_�! a►1 <br /> Contractor's Name .... �..__ ... -- --.......License #13'.?.':` j9....... Phone -------•-•....-- ..... i.... <br /> s. Installation will serve: Residence partment House❑ Commercial-gTrailer Court `❑ + <br /> • see:.._ <br /> Motel Other _ ` r <br /> Number of living units..../..,_.. Number of bedrooms ...:Z...G,arbgge Grinder .._'..___ _- Lot Size ........ - <br /> 1 4,0 <br /> Water Supply: Public System and rX <br /> name . i �'�" ` <br /> ;� ;'---------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand .Sr <br /> P ❑ ❑ Cla� ❑�-- Peat❑ Sandy Loam fl Clay Loam <br /> Hardpan Adobe ❑ Fill Material ............ if yes,type ________________________•-_- <br /> 1k <br /> r (Plot plan, showing size of lot, location of. system in`4latldri=to'-wells, buildings, etc, must be placed on reverse side.} <br /> NEW INSTALLATION: (No septic tank or seepage pit rmit ed i .public sewer is available within 200 feet,) <br /> �. <br /> PE <br /> PACKAGE TREATMENT SEPTIC TANK Sia®.....•-•-••--••-••-•---•----••• ......... Liquid Depth .......................... <br />:> <br /> Capacity <br /> _ Material.....:................ No. Compartments <br /> Distance to nearest: Well ..............Foundation ....... Prop. Line <br /> LEACHING LINE [ j No. of Lines ---------------••-__-___ Length of each line............................ Total length <br /> ___Depth Filter Material ` <br /> D' Box �' Type Filter Material .. <br /> Distance-to nearest: Well oundationr e <br /> Property to ....................... <br /> f SEEI AGE PiT [ j Depth p umber ..----------_------------- Rock Filled Yes ❑ No ❑ i <br /> _._----_-- -- <br /> Diameter --------------­ N <br /> Water Table De Depth ' Rock Size <br /> „Distance to nearest: Well <br /> ........................ ......Foundation .................... Prop. Line <br /> REP) IR/ADDITION(Prev. Sanitation Permit --------------------------:-_,__-___ .... Date ___ .............................. <br /> I .: ) <br /> Srptic Tank (Specify Requirements) ----•.............._:........--••--••. ••-N-•--•..... ,r <br /> 1 �� �l 0,;--•- ------r t <br /> Df sposal Field (Specify Requirements) ---------L .... .�?----- /1- ------------- <br /> ------------------ <br /> ----------------- - <br /> -------------------------------•------•-•.....----....•--•-•-..__.... ---•-••--- .................... ......I •-•-••••-•--•_.....--------------------•........... -------- <br /> (Draw existing and required addition on reverse side) <br /> I he�feby 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. Horne owner or Ilton- i <br /> sed®gents 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 becom subject to Work an's Compensation laws of California." <br /> Signed ..... F <br /> "_ Owner <br /> By ..:............. .................................:..�_.........--=--.-•_............. <br /> _ : Title __..._----•--•_. .............. <br /> (if other than owner) FOR DEPARTMENT-m <br /> USE ONLY <br /> APPLICATION ACCEPTED BY -__-. �.. . __. DATE . .__:�_7.�7 ........-•__---• <br /> BUILDING PERMIT ISSUED - ---------- ----------- ------• - ............................•.----•---•-••-•-- ..--.-••-•--DATE ..................._. _ <br /> ADDITIONALCOMMENTS .................'-•-...••••....•-----------•-• -•••---- --------------------:.--_-----__----------- .......-...............I........................... <br /> . .. <br /> ................�.... ...................................................................-_.___..___.__.___ <br /> .._...__ <br /> ....:..........•-•- -.....-^--••.._...:_•-_-•--••---•-----:......--••-----•-••--._._._....___..._._____.__.---.----• <br /> Final Inspection by: ---............ :.2 N ;.r ------ ------------- ---- --..........`......._....__.._...Date .. .. . <br /> . r <br /> ✓ SAN JOAQUIN LOCAL' H8ALTH DISTRICT <br /> 1.3 f •� � ., <br /> E. H. 24 1-'68 Rev. 5M 7 171 q .0 <br />