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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT . <br /> -176 4 <br /> o- 3 Permit No. <br /> lComplete In Triplicates .............. <br /> Date Issued ../.`3.°~7 <br /> .. This Permit Expires t Year from 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 Count Ordinance N 549 and existing Rul and Re ulations. <br /> ,19 <br /> JOB ADDRI=SS/LO N Y . rl.-,.. CENStiS TRACT .......... <br /> 11 <br /> Owner's Name _- ---- - --- -- ` L -•--------------------•-- .....................Phone . ��.....-..,��...� <br /> r® .__ . � �L ........................................�.........Address -----_------------- . 47/ecg -----IJ .0city ........ -::.�. . G <br /> � <br /> Contractor's Name -----•------•--��__� ,_ ._r9 C� .��,C�._ - o s ......--.license # ........................ Phone <br /> Installation will serve: Residence Apartment House f] Commercial QTraller Court Q <br /> Motel Q Other-•••-•----•..................•-•.:......... <br /> Number of living units:... .--- Number of bedrooms--......Garbage Grinder. ............ Lot Size - -..A.�.h:c—_-..s............. <br /> Water.Supply: Public System and name - """ .._._.._Prwat Q <br /> ---•....................--_.. ......................... e <br /> Character of soil to a depth of 3 feet: Sand Q Silt Q Clay Q Peat Q Sandy loam Q Clay Loam O� " <br /> Hardpan M_ Adobe .Fill Material ............1f yes,type <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.-must be placed on reverse slde.1 <br /> i <br /> NEW INSTALLATION: (No septic tank or seepage pit ,permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{"_ Q 5ize._._ '---,?�.- 0_-_•__--.----•---•---... Liquid Depth ---s ....,..... <br /> Capacity _ r�=D ... Type _ = Material.Q1,7L _-' No. Compartments ....... h-?........... <br /> Distance.to nearest: Well -----(P__Q_r._...--....--........Foundation ...... ... Prop. Line ....lXQ....... <br /> LEACHING LINE No. of Lines ._. .. -------------- Length of each line.._ Q f .... Total len th ....... '..... <br /> U1 <br /> 'D' Box .....i------- Type Filter Material C1. . .Depth Filter Material _.. ................................ i <br /> 7 <br /> Distance to nearest: Well _ �.---_--- Foundation _--. ©.......... Property Line .....� ..:�..Z k <br /> SEEPAGE PIT Depth -- - Diameter-33........ Number __,5--_-------------v Rock Filled Yes No Q <br /> Water Table Depth ------------ --- .-.-.--••- <br /> p r .................Rock Size -....................'3. ••- <br /> Distance to nearest: Well D D <br /> Foundation ........�...._... Prop. Line ..__x.�._.....__..� <br /> REPAIR/ADDITION(Prev. Sanitation Permit <br /> ' ____..............--•-•--••--------- Date ...........___................. <br /> 1 � <br /> SepticTank (Specify Requirements) ...............,...................__•-•-.........................................----•..................................._.............. <br /> • C <br /> DisposalField (Specify Requirements) .........................---------------------------------- .................... ....................................... � <br /> ........... --------- . — <br /> (Draw ex€sting and required add ltian 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 Rales and Regulations of the San Joquin Local Health",District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> N certify that in the performance of the worts for which this permit is Issued, 1 shall not employ any person in such manner <br /> as to become subject Workman's Compensation laws of California." <br /> Signed -- �f-kn,,,_ --•--------- - ! <br /> By -------------------------------•-------. --------------------- ...------ <br /> ----- Title <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �: ---..-----••---••------- •---------------------------------------- DATE .�. .`.:".A ............. <br /> BUILDING PERMIT ISSUED -------------- ------------ - <br /> ---..-------•------------ ------------------------------------------DATE ---------..............--------•--.. ...... <br /> ADDITIONAL COMMENTS -------------------------- <br /> ----------1- -----------------•--------------------•------------ _._.. -------------••- ------------------------_- --.-..--. ------•--••--- -------­---------------- <br /> --•-------__ --------•------•---------------•-•---- .--.... <br /> ------- --------....-.-..------...-------.•--• ----. <br /> -• • ......---- <br /> -------- ------------•- ................ . ------• -------- -•-------•------I----- -----•---------••--•----- ..................... <br /> ... <br /> _ <br /> Final Inspection by: _.__ '_ •---•---•-...-------•----•-•----------------Date . - - .. .......------- -•---- <br /> EH 13 24 1-68 Rev. � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />