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f f 6 <br /> , PLICATION FOR SANITATION PER . <br /> ... . . <br /> .. . ,r Permit No. ..7 �/Oa <br /> •'' (Complete in Triplicate) // <br />,....... <br /> :.... .. .. Date Issued _�/ 7�1 <br /> �! ... This Permit Expires 1 Year From Date Issued <br /> pp ti n hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> sc ibeTh s�application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> �, re .:.............CENSUSr <br /> JOB ADDRESS%LOCATION ..../.��'.i.'C-L...-_.. ..---I.� �'���..L,'.�� -/�J✓-- �, O• . . . _... <br /> Phon ........ <br /> Owner's Name .. .e.r}�. ;d._. .�.... I...__. _ �'�e ..1 �.. . _.... , <br /> 7 ` ._ ......_- - ....................................... <br /> Address ..._..1� r.� ly.�.... . :.�-�r'.�.try.�.��._. . City r:.�.��e`.�:'���1...._.. <br /> Contractor's Name .._._ :Y�L�! ............... ...................License #,r ;7..'.�`. '.. Phone <br /> Installation will serve: Residence Apartment House Commercial ❑Trailer Court ] <br /> Motel ❑ Other ...........................•-•.............. <br /> n _ ._ _. `aY' . . <br /> Number of living units:... ..------ Number of bedrooms sK..........Gar ba9 eGrinder IV-.. Lot Size ............. <br /> Water Supply: Public System and name ............... ... -------------•-- .................... ...........................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ <br /> Hardpang Adobe ❑ Fill Material ............ If yes, type ............................ <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells: buildings, etc. must be placed on reverse side.) <br /> I NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) - <br /> PACKAGE TREATMENT ( } SEPTIC TANK-[ } Size............. ..........................------ <br /> ... Liquid Depth ........................... <br /> Capacity .............. Type ...............'..... Material...................... No. Compartments ............ ......... <br /> Distance to nearest: Well ..................................... ... Prop. Line .............. <br /> Foundation .....---•--........ ...,.... <br /> LEACHING LIN>: ] No. of Lines ....................... Length of each line.................}........ Total Length ...................... <br /> :I 'D' Box ............ Type Filter Material .....•..............Depth Filter Material ..__... .................................... <br /> Distance to nearest: Well ........................ Foundation ....._..__..__.._._..... Property line ........'.......I......... <br /> SEEPAGE PIT E j Depth .................... Diameter Number ..._........._.._....... ... Rock Filled Yes ❑ No-C] <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) .......:........... .. . ,.....------- ...... <br /> y �,1 .' <br /> ► <br /> Disposal Field (Specify Requirements) ._C: ----. 1`._/: ' .......:........... <br /> Dis <br /> p I Y q -- •--... <br /> l......................._.... ....---------..........._..------------._....................................................................--.------•-----.....:_. . <br /> (Draw existing and re-quired addition on reverse side) <br /> I hereby certif� 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, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.” . <br /> �I. . Owner <br /> Signed ........ _. -------------- - ----- - <br /> -------------------=-- /y <br /> By . .-......._: � ..Z : ..................................................... Title ..L : - � �1.. ..,....... .......................... <br /> f f other t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> fd .fid <br /> APPLICATION�ACCEPTi:D BY ..................... ..'--••------•---------------------•-------..._....................... DATE ......... .......... ..� -----....... <br /> BUILDINGPERMIT ISSUED ........................................ ............--•-•••-•.............................................DATE ............................................ <br /> ADDITIONAL COMMENTS ... <br /> ..........................•--...-----•--••••......................... --•--.......................---•-••I........................•... .. <br /> I ......----•••••............................................ <br /> . ..........7...............•-----.._.:_.........._..-----....._.....--'--.....................J,. ..................... <br /> ....... <br /> Final Inspection by: � { � Date <br /> :: <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> dDr u 13 24 ,![-An o.., sAA 7/72.3 M — <br />