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-FOR OFFICE USE: ) %PPLICATION FOR SANITATION PF- 117 <br /> �•�T= . ---=------- --3 � � � o <br /> ./ Permit N . LG�7._�d/� <br /> 3------ (Complete in Triplicate) /`f <br /> - - - - - - - - ---- .L-3.�L�i-- <br /> ------------------------------------------ _-___--- This Permit Expires 1 Year From Datelssued 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 <br /> with County Ordinance No. 549 andexistingRules and Regulations: <br /> JOB ADDRESS/LOCATION yQ 41/ �i-<FLf---=-�- Lr�.--Q6�-6-- -�1(� •--CENSUS TRACT -----------__...___..- <br /> O wner's Name a�� - -------------------_-Phone -- <br /> ` L / <br /> Address _�6-Q ------ y�Gl �gf! ' R:�sF2r-. t1�i--. City � r%J j ------------------------------------------- <br /> Contractor's Name ._,/f0ra-� OQ /- <br /> =----- --------------------.License # -----�-- Phone -------------------------- <br /> Installation will serve: Residehe,❑ artment House❑ Commercial []Trailer Court ( <br /> / Mote{�.[].Ot er ------ ----- --------------------_-- � f <br /> Number of living units: a'... Number of b'edr�ooms.,,b//.-.....Garbage GrinderLot Size��.._614�.!"�.l---------------" <br /> i <br /> Water Supply: Public System and name -------------------- ------------------------ -_....._.___----_.__..__.---_.----_Private K <br /> Character of soil to a depth oh.feet:feet: Sand SiIT D ",Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> ;. Hardpan ❑ Adobe 0 - Fill Material ------------ If yes,type-.__-___---._-__._.--. <br /> (Plot plan, showing size bfi lot, location of system in relation o ells, 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 [rJf SEPTICTANKf Size........._..............----------.----------- Liquid Depth _._.._.._---------_-..- <br /> Capacity ----------------- Type ----------�------- Material,- _-.--_---._._.:--- No. Compartments _.._: (r, <br /> - <br /> Distance to nearest: Well ----- --,�- ------ ------------...Foundation ---------------------- Prop. Line ___t------------- <br /> . <br /> LEACHING LINE [ ] No. of Lines --------- -----.__.... Length of each ,line...-.._._-____..__.._._ Total Length ..__.._.-.-.-_--_---_---. <br /> 'D' Box ______.__ Type Filter Material -_.___----_---....Depth Filter Material .----------------------------------_--.-.-- <br /> Distance to nearest: Well .-_.--. _--_...._.._ Foundation ------__-------------- Property Line ---..................-. <br /> SEEPAGE PIT [ ] Depth ------ --- Diameter _._.---_---.... Number -------- ------------------- Rock Filled Yes ❑ No ❑ <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) ------------------J--}- - --------------�------------ ----- - ---------../.-/ ----------- - -T'---- ----- <br /> Disposal Field (Specify Requirements) ......Q-- /U------{� ------�y ��f✓Fl----� <br /> i <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I Piave 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. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performanke 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 _ � -... -_:- .... Ow?NLY <br /> By ..... -----f+��r-- - -= fir?-1�@fes------------- Title - <br /> (if other than owner) <br /> FOR <br /> DEPARTMENT USE <br /> APPLICATION ACCEPTED BY ------------c'-----`�- ------------- --- ----- DATE L1.`.Y.=.CSI -.... <br /> BUILDING PERMIT ISSUED .. --- -- ---------------------------------------------V-:------------------r------.-...---- ..DATE ---------- ----_-------_------------ <br /> ADDITIONAL <br /> -------- <br /> ----------------------------- <br /> ----p Tri--' - --- ----------- j- �- .- -- <br /> ADDITIOc NAOMMENTS <br /> ------ - --------------------------------- - - - ------ <br /> -...-- - - - - - ------------------------------- ----------- }_ 1�s� <br /> Final Inspection by: --- "-- --....-.._. .- -- --'----`- -- ---.Date -- --- - - -'--"l--'---- ...... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />