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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> .......................... ......................... ICort~p'Ietslnripllcatel - �... _._ _ _. Permit No. <br /> ................ <br /> `` <br /> Data Issued <br /> _....... ..... _.__.__._...................... This Permit Expires 1 Year From DatelssueO <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 applicationis made in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> JOB ADDRESS/LOCATIONI'__...�7,X'..X.' .e.I .1 .....g4re,4 IcENSUS TRACT ...__•.................... <br /> Owner's Name .--_•:-• _ , _.LI:.P�[.!._:. _� Phone _ <br /> Address "__ � .. - •� -............................... 'City .... °.: A. ". ------------------------ <br /> y / <br /> Contractor's Name _l .......................:................_:.:License # _ --/• �.tv_�hone ................ <br /> „�. <br /> Installation will serve: I� Residence(Kartment Housef] Commercial❑Trailer Court <br /> I Motel ❑Other .--••--•-••.......:.......:...•-••=----•--- <br /> Number of living units _.__i Number of bedrooms - _Garbage Grinder ...:__...._- Lot Size �'�X <br /> y - ...._.... <br /> Water Supply: Public S ste <br /> II� �TL�.....' .•1R... <br /> ' m and name ._ ..- --... ....:........-----.......,........................................_Private[� !-- <br /> Character of soil to a depth gof 3 feet: Sand E] Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam <br /> �I Hardpan Q Adobe❑ Fill Material ............Ifyes,type............... ............ <br /> S. . <br /> I� (Plot pian, showing size lot, location of system in relation to wells, buildings, etc: must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepoge'pit-permltted if publicsewer!s available within 240 feet,) <br /> PACKAGE TREATMENT f J'll SEPTIC TANK j Sine...... ................... ... Liquid Depth <br /> # Capacity I . Type !'Wt. Material.'_ _____..L�--•___ No. Compartments _.0L-------__--.--- <br /> - _ _ <br /> Distance.to nearest: Well p$._.. ........... ............ <br /> ............... <br /> LEACHING LINE { j No. of Lines ....... .-- <br /> -•-------------- Length of each line...._. ------.---_----.... Total Length __?.a... �t <br /> 44 __Bax Type Filter Material���.A'a:S. <br /> .. .-Depth Filter Material .......I..`.. �........................... <br /> PAGE PI f <br /> Distance to nearest: Well ................:....... Foundation ___._.._ __. _..________ Property Line .......... ............. <br /> Depth -------- ...... Diameter ----_ <br /> Number -------�._�._,-...... Rock Filled Yes 0 No Q-' <br /> w4wnwww�r�rr � ----------------------------------------------- <br /> ,iter Table Depth ----- -•----------------------•------_(tock Size • ' <br /> Distance to nearest. Well ....................................t..-Founclation Prop. Line .----•.............. <br /> REPAi ADDiilO (Prev. 5d`nitation Permit q4R _.._._._.•---------- <br /> •--................. Date .----•_ ------__---------I s l <br /> Septic an (Specify Requirements). ... _ <br /> ,M ........ • . <br /> Disposal Field (Sp ify R gvirements) _ NA41 _ate_ _ .....-.- <br /> SO . <br /> .... 'a a'''`� ' ,. <br /> .. <br /> ..C6........4. <br /> wr •...: r.- �.. <br /> (Draw existing and.required addition on reverse side) <br /> I hereby certify that I hall prepared this application and that the work`will be dons in accordance with San Joaquin <br /> County Ordinances, State iaws, and Rules and Regulations of the San Joaquin Local Health:District. Notre 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 boos a sub lect to Walrkman's Compensation laws of California." r <br /> Signed �f�-'---�' r, --------------------------------..............._...----------- Owner i <br /> BY ---------•-------------------------- --•-•--- Title <br /> (If other than'iowner) <br /> i19R DEPART ENT USE ONLY l <br /> APPLICATION ACCEPTED a - h,�,�„_.. .__r.._..DATE_ ... .:.:,a'� ... <br /> BUILi31NG PERMIT ISStJED 'i-- ___-- - <br /> DATE -.- ? <br /> ADDITIONAL COMMENTS -!_. --•------• - <br /> ---. - ------- <br /> ----------- - . . . ....... ......................--------------- ----------- <br /> Final inspection by: .._. �,rrr. ,c�- �f --•--•--------•-•--------- -=---- --------•..-----.._... -_"_._ _-__...Date ./..�h.....�.:!� ... .....---•-••---- <br /> ' EH 13 2L 1--68 Rev.I15M SAN JOAOU€N LOCAL HEALTH DISTRICT 8/7h 3M <br /> _ h� <br />