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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT � <br /> (Complet%in-Triplicate} <br /> Permit No. .7 �5 � <br /> :................ �V <br /> -------------_.. <br /> This Permit Expires 1 Year From Date Issued Date Issued -1 _ <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 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION �.i4cy..aL ieo. 4!` NSLIS TRACT .......................... <br /> Owner's Name ......� � .T ----"-. ........ ----•-- --•..... .........Phone ........................._,._..----- <br /> Address �. .. z.r..-- .:.. ................ CityZ <br /> .. . <br /> .... , .....Contractor's Name --._ .-..- ..._.. <br /> # . .. 4- Phone .�1.._S_.-75 <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑ Other __.- ............................ <br /> Number <br /> ther _ .- <br /> Number of living units:..../-,_ Number of bedrooms ....__..Garbage Grinder Y-0. Lot Size _._��.._ ---_--_--........... <br /> Water Supply: Public System and name ........................................................•-----------._.._._..._.. _......-....................Private <br /> Ch&dcter of soil'to a'deptli of 3-feet: -Sand D Silt❑ 'Clay ❑ Peat.I] :Sandy Loam' Clay Loom C] <br /> =- Hardpan ❑ Adobe ❑ Fill Material .._......_.: if yes, type .................. <br /> {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 /> PACKAGE TREATMENT [ ] SEPTIC TANK -Size --. 0.�___--- --._.._... Liquid Depth .........._.:............. . <br /> j } <br /> Capacity .� ���Type .................... Material_ 4 No. Compartments .. .--._._......6 <br /> Distance to nearest: Well ._. --..-• ----_------------Foundation ............. Prop. Line ............____�.. � <br /> LEACHING LINE [ ] No. of Lines . ___. ...._ Length of each line Total Length ..g?L�..7`f._ V i <br /> 'D' Box ..YQ.S - Type Filter Material _.rn!� _._Depth Filter Material /,s�._- ail ...-- . <br /> Distance to nearest: Well _..`, Foundation la..f-f........ Property line .... ................. <br /> SEEPAGE PIT Depth ..._._ Diameter ----------------- Number ----------......_..._...____ Rock Filled Yes ❑ No C <br /> [ 1 A <br /> Water Table Depth .........................-----------------------Rock Size ------------ ------ <br /> Distance to nearest: Well ._...................................--Foundation ------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........ ................................... Date _...-___-- ............. <br /> Septic Tank (Specify Requirements) ..-- . .................... ------------ ------__-----_---- --•------------- --------•_.._......._.._ """"--...."---...__...---.....s <br /> .. r <br /> Disposal Field (Specify Requirements) -------------------------- -..................................................... .• ----------------- •-"-._ ............ <br /> . .............................................. .(.......__--- ...... ....._...__.._.. _ _---- ..___-"---------__._.._...__._.........._.. .............................._.._--_.- <br /> JDrdwexisting 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 Health District. Horne owner or (icen- <br /> sed agents signature certifies the following: t <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 become subject to Workman's Compensation laws of California." <br /> Signed _:. .. `..............."-------" ------- •-- Owner <br /> BY .. - ---- --- --- ... •-• ........... Title . ... ......M. ._.2.�fa• <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..,.4 �. .. . DATE .... .. ..Z �/�-............. <br /> BUILDING PERMIT ISSUED ..._ . ._.- -------------- ----- ..............DINE _..._........ ------- -- .......... <br /> ADDITI AL OMM NTS ----�t v1$'[. . o .L?••-aa ..__ _ ------fJP//+^✓---- 62 t�fn�5--..6✓��e-i :_.f.�1�------.. <br /> �. 4lj��.... 7rV. . .,. .._o _... 5 - �- ......................•.._._.................... <br /> .. <br /> ................. .................. . ....... ...... <br /> ......."-_-._._,J�'./_�.']..... ... _..._.. .._.-.............. ------- <br /> . <br /> ._._. <br /> .................... ------------.--- _-" _-.-. ......_ ._. .__..__Y l .. - _....----" _ ._..............__..................... •._------ <br /> (Y/l� _ ..._, <br /> -- -- Date <br /> Final lnspectio ...- •- -- --•....:.......:..... .. - -----._._.. ........---•- ---------- .. ..-----•---- •----.._. .._.... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 71-2 <br /> E. H. 1.3 24 1-'68 Rev. 5M <br />