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V/ FOR OFFICE USE: <br /> FOR OFFICE USE, ' V APPLICATION FOR SANITATION PERMIT <br /> " Permit No.7r::- 'a <br /> -- (Complete In Triplicate) <br /> ........................ ..... <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 andinstallthe work herein describes <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> _.... . _ .t................ <br /> NS R - ---------- <br /> JOB <br /> ....- <br /> GL/ w <br /> CE US T ACi <br /> JOB.ADDRESS/LOCATION... ......°: �------------- ------- i <br /> I 7r . �� Phone..---- - --- --------••-- <br /> Owner's Name- .... U'wsti' sCJt/+�J... .................. - Q . I -- - <br /> Z <br /> Address. ....... ,. cJ!..-... . .. ....................... - --------------- -one <br /> city. �, <br /> tQ� ...... <br /> t .............License .-..Ph <br /> Contractor's Name..:....... - ��`+- <br /> Installation will serve: Residence_( Apartment House❑ Commercial ❑ Trailer Court ❑,. <br /> i j Motel ❑ :Other...... :--......_- <br /> . '� . <br /> Number of living units:-_-.�.........Number of bedrooms.:---._Garbage Grinder,_.z...----Let Size...............__... ... , f <br /> r, . .. •-----...Privat <br /> Water Supply: Public System and name-----.......---`..... .. .:. ..:-�--T....------ --- -.. <br /> -- e <br /> a <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt E] 'Clay E3 Peat C1 -;'Sandy Loam❑ Clay Loam _ x <br /> Hardpan ❑ Adobe❑ Fill Material...:------If yes,type---,--------------------- ---- - s <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc. must be placed on reverse side.) <br /> I NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is ovailable'within 200 feet,) <br /> A .. �X�O / e� / <br /> PACKAGE TREATMENT I ) SEPTIC TANK I Size.�......_.........rr7 ---------=---------- -•-----Liquid Depth.-...�j�- <br /> Ca aci >'(on,6 T e.. Material..-"-=.............-------- No. Compartments--._......------.--_.---.--.- <br /> i P tY YF / �-- <br /> ` _ LY-- <br /> Distance to nearest; Well- -- -----=------..-Foundation.........1.47-k---...Prop. Une:,�:SL'- -----• <br /> LEACHING LINE; . I;1 No. of Lines:.. :. ..'.....Length of each line.......4.0 J -------:Total Length...... -.--- <br /> r D' Box..,-......Type Filter Material_.--.-.5.9----Depth Filter Material....--.. .......... ............ <br /> I <br /> once to neCar-et: Well-•... . ... <br /> . --­--------- <br /> SEEPAGE <br /> Iy Line.'........--.eDeistrRock Filled f <br /> No-SEEPAGE PIT Depth S Diameter..... 0Number <br /> t <br /> / / N <br /> Water Table Depth..-- .......� f � . Rock Size..... -3....................... <br /> I <br /> Distance to nearest: Well:.:_!`--rc --- --- --Foundation..:..t!. --.-_Prop. Line._. .. ... ---- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#.......... --------------------.Date----...........- -------------------) <br /> Septic Tank (Specify Requirements)---------.1.............:........................................................ <br /> pY <br /> ...••------------•--.........•••------ -. <br /> Disposal Field (Specify Requirements).......:.............. ....------.....•--------•-----...:.......:..••----......------•----.....--------- <br /> 9 <br /> ............................ <br /> t - <br /> .........-...... •._..................- ------'------------------------------------------------------------ <br /> - ........................................... <br /> k ) . i- " (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed age <br /> 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 /> I M become subject to Workman's Compens ion- laws of California:" <br /> Signed------------------------------ -------------- ------- - - --- -----.Owner ^- �- _ 8 � � <br /> By........ ... itle.... 6 l�Kil..... ...'--:--------------- \� <br /> ----- / CAy <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY' <br /> APPLICATION ACCEPTED BY-C.---------I-.------------ ..........DATE..9...Z .7J---------UP---- <br /> DIVISIONOF LAND NUMBER.. ..........` . .........1-'----------................,............. ......... .............DATE..-......... ----------------------------- <br /> ADDITIONAL <br /> ---------------ADDITIONAL COMMENTS-------------------.........................-------------- ................................................. ............................ ... ........... ...... <br /> ..................... -------- ----- ------------------------............ ....... ... ---.•---....••----------------..........•........•.......-- ...... ............--- <br /> 7 ..........................- " J <br /> nspection•by-: ........................................... <br /> ------ <br /> aFin ---------....DatfQ --....-6----'ra <br /> szlsnrry n <br /> ,^.�,uw, I/ Al UCAiTU nICTD11"T <br />