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FOR OFF CE US <br /> kPPLICATION FOR SANITATION PERI <br /> Permit No. <br /> f / (Complete in Triplicate) <br /> 337-/ <br /> Date Issued <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. fhi[ application is made in compliance with �County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ----� 7.---{ - //_-�` � _-_._.......__ _CENSUS TRACT ".....".....------..--- <br /> Owner's Name ..... i""....-r--J9N4ZF�CIV----------------------------------------- -- -------------------------__-----.Phone ...."..-----:--------------------- <br /> Address .. W...3 PU. - - - City ---� L Ct,rL��i................................................ <br /> Contractor's Name ..�1 ------- /. --------• ,-e- ---------------------License # ,l/� --- Phone - <br /> Installation will serve: Residence 20 Apartment House❑ Commercial []Trailer Court ❑ <br /> Motel ❑Other ..-..".".-- ----------- -------­------- - <br /> Number of living units:--/...... Number of bedrooms A.--_Garbage GrinderI/r2"._ Lot Size Ql< ---.- ----.- ------- <br /> Water Supply: Public System and name ..-....--------------------------------------------------------- ..........................................Privateer <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe B Fill Material .."" ..... If yes,type--"._.."."_.__.""_.-_. <br /> (Plot plan, showing size of lot, location of system in relation to wells, 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 [ ] SEPTIC TANK{ ] Size......"-....----_-"-."._--------------------- Liquid Depth ......................... <br /> Capacity . .................. Type -------------------- Material-------- ------------- No. Compartments ------- \P <br /> Distance to nearest: Well --------------------------------.---Foundation ---------------------- Prop. Line ......----------- ---- S <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line -------- .............. ... Total Length ..........._.:............. 2 <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 ❑ D <br /> Water Table Depth ...------ - - --------------- ----..Rock Size -------------------------------- <br /> Distance <br /> ------- -- <br /> Distance to nearest: Well -------- -------- ---_-."""".---"-"....Foundation .....""......."..."" Prop. Line .........."- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ............--------------._----..-.----_ Date .---_--------_- ---------------1 � <br /> Septic Tank (Specify Requirements) -------------------------------------------------------------------- ---------.."..-...."..... ........../-...------�-----'-�P� <br /> Disposal Field (Specify Requirements) .--.��E.. ......�iF c�a��11� 1- 9i&l - -- -7- " ---�«�'�� " <br /> .......... . .................. ---------------------------------------------- ..... . . ... . -------..... ..... - . . <br /> (Draw existing and required addition 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 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 performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become su ec t W rkman's Compensation laws of California." <br /> Signed -`-- - _ .- .. .- ---. Owner <br /> By . . .---- - ....." Title <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -T---------` �.. .......L-... <br /> BUILDING PERMIT ISSUED -- ----------------- - - - ..._ ---------DATE ..-------------- ---------- -------- --_.- <br /> ADDITIONAL CO ENTS . .." .......--- -.. S-Qd�. f 2 _........".. <br /> - - - <br /> � --."...- ------------------------------ <br /> ------------------- <br /> Final Inspection b y .'.-'-"-". . ---- <br /> � --.-- e <br /> SAN IN <br /> LOCAL HEALTH DISTRICT <br />