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ov <br /> FOR OFFiCE USE: APPLICATION FOR SANITATION PERMIT / ,` <br /> Permit No. ....... ". <br />_...,... <br /> ..................I.,...................... <br /> (Complete in Triplicate) <br />......................................................... s � <br /> . <br /> Date Issued ...... ....:..7... <br /> .. <br /> .............................................. This Permit Expires 1 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 County Ordinance No. 549 and existing Rules and Regulationss <br /> JOB ADDiES�%COCAT'iA f. 9 i�✓I �T1�. CENSUS TfIAGi` ........_. ...... <br /> ..... .i ............. .. �L <br /> f':..l►�r 'D..... t.,�.F AA....................... �hn .. <br /> Owner's Name ._ � � .... ...----- Pe.................. ............ <br /> x Address .........Z-3 .... .:...... ....................... City ... G=........................................ <br /> ............ <br /> Contractor's Name Q V1!/J .:} : <br /> ........... ..I..... ..................I._......_.License # .........,............... Phone .............................. <br /> Installation will serve. Residence Apartment House 0 Commercial' Trailer Gearr <br /> Motel.0Other ............................................ ' <br /> Number of living units:...... Number of,'bedrooms ..Garbage Grinder (.X:i .... lot <br /> I... Size _. � `. ........ .... <br /> Wafter Supply: Public System and name!• ... - ...._.. Private <br /> -� `�--... . y <br /> Character of soil to a depth of 3.feef: Sane'] _61keB- CI-41-0Peat❑ Sandy Loam {] Clay Lorin <br /> , <br /> If <br /> Hardpan Adobe [] FIII'Moterial .t estype -_ <br /> y ...------_................ <br /> (Plot plan, showing size of lot, location of! system in relation to wells,_buildings, etc. .must be placed on reverse side.) <br /> 1I ' erg <br /> NEW INSTALLATIONsewer is available within 204 feet,) Ef <br /> • {No septic tank or seep pit perrinitted ii ublic f <br /> PACKAGE TREATMENT [ ] SEPTICTANKf Size._.�'.._�XL ..X...- ........ Liquid Depth .;__!_. .......••.... <br /> Capacity Type isl. Matendl.e��C__�No. Compartments ...:. ...........:... <br /> istonce to neo est: Well ..... :_. f ........Foundation <br /> _149..-'Prop. Line.: - <br /> LEACHING LINE [,J/" <br /> No. of Lines .....f._>............. Length off each line.__.... _.._ Total Length . ..... ... <br /> 'D' BoxY��5_ T e Filter Material /"?.A .Depth Filter Material ...� .....-_:. ._... <br /> s ;•;--L-,- <br /> Distance to n a stPWell _ unciatio�►-� 1� f -=- Property;Llne _..__._:... ..... <br /> .._. .._ l-J i /--- <br /> SEEPAGE PIT Depth f ; D.iameteo -;� umberi' _/.-' 'W Rock filled Yes No ❑ <br /> �- <br /> • Water Table Depth --.-.... . _ ............Rock-5iz <br /> i ti it r:'. f� •.. r <br /> Distance,to nearest:Well ........................................Found on _1 ....:........ Prop. Line ..... ..._..... <br /> t f , <br /> REPAIR/ADDITION(Prov. Sanitation. Permit# _........................................... Date............................ 7. � <br /> Septic Tank S eci Re Requirements) I�vr .. �I•---- .__ ................ I- -•----fir <br /> C <br /> Disposal Field (Specify Requirements) —ODD d/i;'i�- ..-I. :-.-.-: ...�E._. <br /> ti <br /> .........................1­1..................... ................... ..................................-..........................•............ <br /> .......................... <br /> ..;............ ------------ <br /> vf (Draw existing and required-addition on reverse side) <br /> I hereby certify that I haveiprepared 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. Home owner or {icon- <br />' sed agents signature certifies the following: , <br /> "I certify in the perform` ce ofF <br /> work for which this permit is issued, I shall not employ any person in such manner <br /> as to be a subject to Wor an'spensation laws of California." <br /> f Signed . . __��:.. .. .... Owner <br /> . ... Title .................... :................................................ <br /> By <br /> .............. ............................... _ <br /> (If other than owner) f <br /> FOR DEPARTMENT USE ONLY F <br /> �....- <br /> APPLICATION ACCEPTED BY .....�- ....................... --•-•........................... DATE I .. -•-- <br /> BUILDING PERMIT ISSUED ............_....DATE <br /> ADDITIONAL COMMENTS ........... ....... :: ..... ......... ............ ................. <br /> :........... <br /> w-v. _ _ - - - ---- - --_ _ . -....._..._.._......_ <br /> �T ........ ,` ,.e j. 5�y..! .._..... " '.............:.`. :.`""":.;.�... ........_..................................... <br /> .... <br /> Ji L ._ ................... :......_� <br /> - ----- <br /> Final Ins actio -u -- - - - :......:.....::Date .... .••............... - ........... <br /> p = = ..... ........ . ....... - t �- <br /> IF <br /> c SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ' .. ., <br /> IA 24'. An n___ rai <br /> 7/723 X <br />