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FOR OFFICE USE; FOR OFFICE USE: <br /> / ! APPLICATICIN FOR SANITATION-FERMI l <br /> ........ . . .... .. Permit No. 77'.v-r�� E <br /> 4 (Complete in Triplicate) } <br /> ..................... ... 7 <br /> k �.. � � I Date Issued <br /> ........... ... .. ... ... . This Permit Expires 1 Year From Date Issued I <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This r applicatign is made in complience with County Ordingnce No.549 and exiting Rules and Regulations: t <br /> JOB ADDRESS/LOCATION.� - �.s'� �+�s.C/`�� ... i.i CENSUS TRACT. --....................... <br />! LL /� <br /> Owner's Name.......� .Y`.. ?tom....... . ... Phone. .72/..-.1 .�3......... <br /> GC- <br />� Address.........�.rJ../..�....��tc .. y 3 '':_ ... ..... ........Zip_.....-...-.................-. <br /> . .. ... Cit . . p <br /> Contractor's Name...-. �� License. # b`�/7/ .....Phone.��,��.�. / �••• <br /> Installation will serve: Residence❑ Apartment House G Commercial LX-'-Trailer Court ❑ <br /> Motel [1 Other.... . <br /> . <br /> Number <br /> re ndeLot Size <br /> i <br /> Public and nameGirbedrooms <br /> r <br /> 3oX.. . ........ <br /> WaeSupp(y! <br /> Character of soil to a depth of 9 feet: Sand❑ Silt❑ Clay❑ Peat i] Sandy Loam Clay Loam %S <br /> Hardpan❑ Adobe ❑ Fill Material.. .. ....If yes,type e <br /> [Plot plan, showing size oto wellsf lot, location of system in relation buildings, must be <br /> c. p�laced on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available w;thin 200 feet,l <br /> PACKAGE TREATMENT SEPTIC TANK Size..i/z .... ........... ....'... .. ...Liquid Depth .T.................... ' <br /> Capacity.). �9O0......Type Material .. No Compartments.....2...................... . <br /> Distance to nearest:Wel! .. ..............Foundation <br /> ation ..LO..............- Prop. Line...... ........... <br /> LEACHING LINE No. of Lines ..... ..tt.............. y of each line Materia, otoI <br /> Length. .�ol�. ....................... <br /> Depth Fillet <br /> Length /Q. <br /> D' Box............T a Filter Material ...- � P � �... ......................................... <br /> Distance.to nearest:Well...C c1�1— Foundation... ...-. Props <br /> YP 4 . . <br /> /�....... 1 Property Lina....�}�........................... <br /> r . . . Rock Filled Yes Nr No❑Depth ifr�l6�eter. ...�. . ..Numbnr. .�.. ... Rock Size....... ' <br /> / 'y <br /> Water Ta a ept!� ........................ .. . r, <br /> ri <br /> Distance to nearest:Well fZ '............... Prop, Line.......... - <br /> ..... ........... ......... ... ..... :Foundation... . <br /> REPAIR/ADDITION [Prey. Sanitation Permit#........ . ....... ...... ....... . ....... ..... Date . -................ .....................) <br /> . 1 <br /> Septic Tank (Specify Requirements)...................... . .............. ..........:... ...... ................................... <br /> Disposal Field {Specify Requirementsl.................... . . ................................... ........................................................................................ <br /> ................................................................... ...............----.................................. ................................... ................--............ ..... <br /> - <br /> ..................................... ................................... <br /> s <br /> (Draw existing and required addition cn reverse side) � c: <br /> I hereby certify that I have prepared this application and that the -work will ba done in accordance with San Joaquin County ` <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents <br /> Signature cerHfies 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 as ' <br /> to become subject to Workman's Compensation laws of California." <br /> Signed - [I otheC�jr . ...-,...... w <br /> pe <br /> Title.. <br /> ........ h ................. <br /> ... <br /> . than ownerl ....... i I <br /> R DEPARTMENT USE ONLY 6 <br /> _ APPLI ATION ACCEPTED BY-.._.... .......... ......................... ...... . DATE ..... ...... <br /> - .... -. . <br /> DIVISION OF LAND NUMl3fR.. d ` DATE. . .. . .... : ................... <br /> ADDITIONAL COMMENTS....... ... v .... ... ... . ..... <br /> ....................................... ...........................................-........... I.............. .......... <br /> J ........:... .. .. .......... . .. ............................... <br /> Final Inspection by../ ...::/• �!! .-L /r L .... ........ ..:..:... <br /> _ ..Date,.. . - <br /> Eli 13 24 SAN JOA{U1N LPCAL HEALTH DISTRICT F&S 21677 REV. 7-76 3M <br /> a ' <br /> l <br /> f <br />