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FOR OFFICE USE: NPPLICATION FOR SANITATION PF- 'IT <br /> ___.. ..... .........................._...... r..rG� <br /> _ (Complete in Triplicate) Permit No. <br /> �./ .7/.....�_.. ... <br /> _......._................................. Date Issued �� 7V <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 Ss made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . ... .._.. _,.2 S"'-r/A.N. .�5 ...- �A....r.. ... ......CENSUS TRACT _.... . <br /> Owner's Nome ...'.r.e. . Nn. ''.�,,,-l!........ ....... �.et! ..b..........--.......... ....... .p...-............Phone ...-.....---- -.-..-.....--....---.. <br /> Address . ._.... ��.� q .�y ..... . vE ......AM.Y--....-. City ........►..1A--�-��-........................................... <br /> Contract 's Name .......�. ...\l. �.J. .PL.T..._........ --------------. License # ..._..-- - -...-, Phone .............................. <br /> Installati n will serve: Residen ariment House:Q Commercial❑TrailerCoyrt <br /> Mtel ❑Other ............................................ <br /> Number f living units:..-�....... Numbe7of bedrooms � Garbe-Grinder ..�_LotSize - C EAE <br /> ............. <br /> Water Su ply: Public System and name../............................................ ...-- - --------------............................Private 8-� tA <br /> Chars g'of soil to a depth of 3 {este'ioncl❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ � <br /> 1 ' Harldpon ( =Allose ater a . : f yet pe 7....................... <br /> ^ � <br /> (Plot p"l�oA, showing size of 1 0 cat+-of-system_.fn_xelat.Ion to.Zel]3. bvildings,_etc._inust be placed on reverse side.)\ <br /> NEW)ry TALIATION: (No sepfl tank or seep pit permitted If public sewer is available within 200 feet,)//��_!!,, �r <br /> _ PACKA;t TREATMENT ( ] SEPTIC TANK Size..._!C.�Q..x- ... Liquid Depth .-./...Q............... <br /> Capacity �.�0�..-. TypeS�MaterlaTC -No, Compartments ...-.Z.. ...... <br /> __ istonce-to nearest ell ..... gyp.... .........Foundation .�0.-. ..... Prop. Line .:5.............. <br /> r di <br /> LEACHiTVG LINE No. of 41rJes .. .... .:. ... L gth of each line_..,�Q............... Total length .....�4�.........-_. <br /> /y D p �c <br /> Box/y Type ilter MaT rial Arr.�6•••Depth Filter Material ....J/---.....-............j........... <br /> SEEPAGE Distance to ne resftl all ,�t .. .. ......... undal9n .....AQ............ Property Line .�---...--.-....-. <br /> p1T [;] Depth .. .......... , .�D�ameter ..-..-.'-.:....rN.,VT 0W J........................... Rock Filled Yes ❑ No Q <br /> Water able^D pth .... ................. ..........t.. . .......��oE{k Size ................................ <br /> 4 Diston a to nearest Well ..............rr'......�.....,�,rr..iaLndation ,.........-......... Prop. Line ...................... <br /> REPAIR/ApDITION(Prev. Sanit tion Permit .................................... date .•........I.......................) <br /> Septic ank (Specify Require a ts) ... -�. ............................. f .4 ,....-.......... <br /> p�, f <br /> Dispos Field (Specify Req+ irrned is}:i. ............................. .......... ....................................... ............. ........................... <br /> �, v �- <br /> ................[. ....._..................... .j...i'...-.C...-:j..-......................,,.....,5..... .......--.............................-.............. <br /> -.--....;, ................... <br /> t lI t ^ <br /> �O,Sra�,exisifng and requlred�ad iTion on reverse side) <br /> 1 hereby erti that I have pr pareXthiis applicatnon-cmd-thatrtl a work will be done in accordance with San Joaquin <br /> County O` i� noes, State Laws,and RulSsIand Regulations of the San Joaquin local Health District. Ham* owner or licen- <br /> sed agent*si' ature certifies the following: <br /> "I certify the erform tha VOrk for which this perm t Is Issued, I shall not employ any person in such manner <br /> as to beco b[e a WaWo'n' ation laws of Califon to," <br /> Signed .... -......... �. Owner <br /> By ..-. <br /> \. .... .................................. .. TA Title ... ......... ................ <br /> f other than owner) t t VN V., <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATI N, ACCEPTED BY ........ ..f. .'.yam r _. .- ................... DATE ---i; .....`... �.7 .-.....-_. <br /> .... .. i , <br /> BUILDING PEF{MIT ISSUED ........... .... .............- -.x .........ftZLE t-......:T..........�:.};;...,..��..DATE .... ...--.....-.....-.......-............. <br /> ADDITION L COMMENTS ......... . .......5.,................. .-. .-........................-..........::..........,; ............................... <br /> _..... <br /> ......... <br /> .. .... . <br /> -. ` / L <br /> Final Inspection b f } .... F�.. .. .....Date <br /> SAN JOAQUIN. LOCAL HEALTH DISTRICT <br /> c u 13 24 1-•AD De.. SAA 7/77 3 M <br />