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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT II <br /> - -------------------- -- (Complete in Triplicate) Permit No, 3-"44_-_(a <br /> --------------------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued ----- <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 N6. '549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATIO /10Z3---------5VESS-------4-- , �_,- -----------------CENSUS TRACT _�_-S -------- <br /> L <br /> _____ <br /> Owner's Name ---_- -- <br /> I�k►'t r _ ��� -:--------------------Phone ------------------------------- <br /> Address ----------- -I------/_Y.Q--------1_1_NeE1:1.71 ------------------------- Cit a <br /> Contractor's Name M-�1�Q1� S4<K/'OE---- License # ---------:---- Phone ------------------------------ <br /> Installation will serve: Residence �rtment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑_Other <br /> ------ --------------------------- <br /> Number"of living units:.-_. __- _- Number of bedrooms ____Garbage Grinder . Lot Size /J ---------------------.__-._-- <br /> Water Supply: Public System and name -------- ----- =- ------------------------------------------------ Private ®— <br /> ------------------------ - - <br /> Character of soil to a depth of 3 feet: Sand' Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> ❑an d <br /> Har €p Adobe ❑ Fill Material If yes, type ------------ --------------- <br /> [Plot plan, showing 'size of lot, location of system in 're`ation towells, buildings, etc. must be,fslaced on reverse side.) \ <br /> NEW INSTALLATION: <br /> (No septic tank or see ge pit_permittedppif��ublic sewer i available,within 200 feet,} c( 'A <br /> PACKAGE TREATMENT [ ] SEPTI TANK [ f Size..7-_x_1 __- -_ __ Liquid Depth --_LS—� <br /> Capacity ___t9_ - ----,---- Type Materialep_�..Kr, Compartments '�- (� <br /> - (.J <br /> Distance to, nearest; Well ------ __'�-_______Foundation �Q___ ____ prop. Line __ " .___ <br /> E / <br /> LEACHING LINE [ No. of Lines __�� ____________ Length of each line--- Total Length -� ............... <br /> 1� t. <br /> D' Box _F�Type Filter Materiel RV -.-Depth Filter Material - / ---___________-______f_____._____. <br /> Distance to nearest: Well___W, Foundation ._ Q__ -1­­..P_roperty, LineIt <br /> ecen�ve=r�tvc+Ri_r [Depth --- _X�(�_ Number --- <br /> .. ___ Diameter --- <br /> ' + � _ Rock File Yes No i❑�''�' <br /> PGE1 EA BED-< Water Table Depth --- I <br /> .� - Rock Size - =t------ <br /> Distance to nearest: Well --------------------------Foundation - ----------- Prop. Line ____�.____`f`� <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -.___-°_________________________ __1r_}'DcEte►___�__--i_ � _ <br /> Septic Tank (Specify Requirements) � - ___k1 - =r a----------------------------------•----..---------------------------- <br /> � _ <br /> Disposal Field (Specify Requirements) ------- ------------------------------------------------------------------------------------------------------- <br /> ------------- ------------ --- ------------------------------------------------------------------- <br /> --------------------- _. -- -- -_ --- .r� ._,-__ <br /> ---------------------------------------------------------------------------- - ----- - <br /> ------------- ---- <br /> (Draw existing and required addition on reve�se 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 I Local Health District. Home owner or licen- <br /> sed agents si ature certifies the follow" g: �, <br /> "I certifin the pe ante oft work for which this permit is issued, I shall not employ any person in such manner <br /> as to bsubject t man, mpensation laws of California." <br /> Signed � - Owner ! <br /> --------------------------------- - <br /> BY ---------------------------------------- --------------------------------------777__4R-_V__ Title ----------------=- --------------------------- ------------------------- <br /> jif other than owner) <br /> FOR DEPARTMENT USE ONLY --77,� <br /> APPLICATION ACCEPTED BY -- --�{�- ------- ------------------------------------------------------------------- DATE ----�-ZS-_7---------- <br /> BUILDJNG PERMIT ISSUED _. _ -,.— -- -- �..- --------- >_-.-� _. - ------- ------------------DATE -.--:-- - ------- <br /> ADDITIONAL COMMENTS ----__ <br /> _ <br /> - ------------------- .- <br /> ---- - -------- ------------------------- <br /> --------------------------------------------------------------------------------------------------- <br /> - --------------- ------------- ---- --r _ <br /> 2 ` `�t <br /> Final Ins echo i -- i A -------- r , , U `�7 <br /> p ` Date -- -�Z- -- -� - ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />