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- —•-sem <br /> FOR OFFIC�,IJSE: APPLICATION FOR SANITATION PERMIT r c <br /> .................... Permit No: 4 47_7b��3 <br /> (Complete in Triplicate) <br /> _:...._------------ <br /> ----- --- ............ - --... <br /> ... - _... <br /> -� This,Permif Expires T Year From Qate Issued Date Issued ..6 <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 ex sting Rules and Regulations: <br /> SOB ATiDRE$S/LOCATION ... _llJ ..- S�6 Yf.-r!G/ .1�!n��K.:...... .. 5.....:......CENSUS TRACT D7f S <br /> Owner's Name ---------nfV.P7C/..a✓..�FIJt.--G.Q�/��v.4(.F.f.�l�_....5.;�1_..'.".-"- -------"-- ......__....Phone.40._...Vaf..a�� <br /> Address -------_..._City '--'--....---......-"--•-'-'---'--'-----...,._-----...-•---"'-....... <br /> Contractor's Name --- .................-------............---.--+.......LicenseF#/.L .- ' -... Phone ......._..................... <br /> Installation will serve: Residence []Apartment Houseo Commercial J]Tra)let Court �( i <br /> Motel n Other..__.._.. ..�.+. .. ,�:.-....-_._.•- <br /> �y \ J ' ieYeS r[dYAKf1C. e <br /> Number of living units:.._.X--... Number of/bbedrooms ....__-----Garbajge/Grinder . / '_.1Lo�t S,ize ................. .................WY <br /> Water Supply: PublicSyste/m, and name 7�, fd �Cz34.+ ....w __sJ.�fJ !!x...... Private❑ <br /> ................ <br /> Character of soil to a depth of 3 feet: Sand❑1 Silt❑'�.." CIO ❑ PeaYX Sandy Loam❑ Clay-Loam❑ { <br /> C r f <br /> Hardpan [] Adobe Fili'Materia) NO <br /> ....If yes,type............................ •� <br /> r <br /> (Plot plan, showing size of lot, location of system in relation to'wells,,.building's, etc. must be placed on reverse side.l U1 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted f public.sewer is available within 200 feet,)/' _ t <br /> PACKAGE TREATMENT (( SEPTICTANK•t ] % <br /> t"i � Size. S_.X p_L ------- Liquid Depth <br /> Capacity Type Z..__. _ - <br /> f <br /> � Material 4M.. Compartments <br /> _. Prop. LyneDistance � . _��.._� IZAV _IQ 1 <br /> LEACHING LINE No, of Lines ...... . ........__._ Length of each fine------- ... Total Length e <br /> D' Box ..:._ Type Filter MateriahL. CI .?� OepTh Filter Matariot ...... <br /> I f/`-� <br /> J. Distance to nearest. Well ...; ./,f1Etf_.,.. Foundation t�lf.�.4flf._..... Property Line, eJ.................._ <br /> SEEPAGE PIT [ J Depth Diameter ................ Number ................ ........... Rock Filled Yes.'❑ No f❑� <br /> Water Tabte Depth' ..--••-•---•-.........e:.......:...........Rook Size-"':a'l "-•----..... ... ., _. <br /> Distance to nearest:,Well _... - -___.o.�.._.._.._.%.`...Found3aytion _.r,'._.._._.-_-... Prop. L)ne�R,.".................... 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................:......... ?.....: ...a Date ....t......... ................ <br /> 1 r) <br /> Septic Tank (Specify Requirements) ` .. .f Y °e 1 j <br /> Dispostll Feld (Specify Requirements) -'--------------`..'..._:.........:............:.----- --...... ..'---.........................`...... -- --- JJ <br /> ..----------------`..................__........-------------'---•--_............................_.............. <br /> ............_.......... .................... -----------............. <br /> '-_.. <br /> ........................................................ ............._.....'^-'-"----'- ....•:...............................,...................... <br /> . <br /> (Dedw existing and re'quired'ar]difion on reverse side) <br /> I hereby certify that I have prepared this applicatiand thit.thou work will[ bet done In accordance withSonJoaquin;i <br /> County Ordinances, State Laws, ano-Ruiesand Regulatidins of t e.San Joaquin Ucal Health District, Home owner or Ilcen- <br /> sed agents signature certifies the fok'King: ' t/ ,?t� 1% 1 . e`''•r' t <br /> "I certify that in the performance of 16e work?for6lth'tks+liarit az:sed,`I ohall stet e\ley penen.;int1h ma <br /> nner <br /> as to become subject to Workman's Compee dtlon laws of Callfom)a.^ {, _ + <br /> J 1 <br /> Signed......................`_..;...:.."--- - -'�L i� Owner <br /> Y By.........----_----------------.......... ........ .. _ , . .......M ~ <br /> ............... ------ <br /> (If her owns <br /> !fy / i yjOFOR.DEPARTMENT•'USE ONLY <br /> APPLICATION ACCEPTED BY..__---..- -..._ .. .fF/n . .r.� l9�ilf_. �G r........:........ DATE .•� .!? .. ...."_.__.... <br /> BUILDING PERMIT ISSUED... ............. fx.. DATE•�_..._..._,_...._.........._.._.._.._. <br /> ADD)TIONAC_COMMENTS---.T. -._. ..?f..... ...'3�'..?�F..iL.. OLf ..r .L.c_._....._�...d. <br /> . --- '-'--- <br /> ................:..:.........._....._....."""--•__._.._..._._..:—f...--= •`_---------- a.............__C{'._----..`......:i."..................................... <br /> 4 .................:e....::!! .......n.:•._.-4-__ .. tom. _-.._... ._._?._._.� ", � r:__`.�..._......_._........_ ....._._.._.. <br /> . ry:., ............. <br /> Final Inspection by:...--'--'- ---..... . ...._., '� •--� -------------- ------- --'--- ----- ......_........ <br /> -- <br /> e. r. G a <br /> SAN JOAQUIN- LOCAL HEfl`HiDISTRICT <br /> E.H. 9 1•'68 Rev. 5M <br /> � <br />