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s_t FOR OFFICE USE: <br /> .. t <br /> a ; APPUrAtION FOR 5.4NITATiON PERMIT <br /> 7 S'-�S�•�� .. .:........ .............. ;, (Compfofe in Triplicate) Permit No. .,,-,.., <br /> m <br /> This Permit Expires t Year From Date Issued <br /> Date Issued <br /> kr.� <br /> °`•' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein, <br /> r described. This application is made in compliance'with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADORE <br /> S$/LOCATION <br /> �•n :6.//.,•..'Y.\.......�_.... �.:{tiz/r. '.. CENSUS <br /> TRACT .........Owner'S Nome hone AddressPhone . <br /> , <br /> - a <br /> ,d Contractor's Nome C [t•�i .......................... City <br /> ..C...rn..t�..-Q�lr v .... ...----•--� ............. .... <br /> ' .Y►..................:....................... . ..... <br /> � Insfailatian will serve: '• �.._�......License # <br /> � � a-.�-.7._-•- _••-�-�-- <br /> g Residence[�Apartment House 0 Commercial oTrailer Court 0 � <br /> rsi Motel 0 Other.......... <br /> Number of living units:.. <br /> ....... Number of bedrooms ,.......Garbage Grinder Lot Size s� <br /> Water Supply: Public System ystem and name 4_.. �:�.�et..:................. <br /> ...._.... <br /> ..................:.. __ _ _ <br /> t 01, <br /> Character of soil to a depth of 3 feet: Sand .............. <br /> .............................Private i <br /> y CJ Silt[J Cloy Peat[] Sandy loam E] Clay Loam ,+ <br /> .,� _ e•rC l 1 rdpon 0 Adobe Fill Material....... <br /> r C3 .. .. <br /> . <br /> If yes,type.........................:.. <br /> (Piot pion, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.} I <br /> z NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available wfthir�200 feet,( <br /> PACKAGE TREATMENT ( ) SEPTIC TANK j ] <br /> Size.......:.............................:.......... Liquid Dept% .......................... <br /> Capacity .................... Type ........ Material...................... No. Compartments <br /> Distance to nearest: Wel! � <br /> LEACHING LINE . -. .g.........................Foundation ...................... Prop. line ................. J. I <br /> ' ...�� [ ] No. of Lines.. ...... -.Filter Material of each line.,...... ................... Total length <br /> yP . .....:........Depth Filter Material <br /> ................... <br /> Distance to nearest: Well .............I.-....... Fovndation Property line ... <br /> SEEPAGE PIT <br /> [ } Depth .�.�-.F-�. . Diameter Number ............................ Rock Filled Yes ® No (3Water Table Depth ...�..(.-('' . .......Rock Size ........1.. ._..`---- <br /> Distonce to nearest: Well -.l.-�.-0!........................Foundation Prop. line ./-..r.�`�•- r O <br /> L•4!.Q. .. --- <br /> r REPAIR/ADDITION(Prey. Sanitation Permit# ............I........... . ..>� •---.-•---... Date .............. J � � <br /> Septic Tank (Specify Requirements) ............. <br /> .............::.:... ...._......:......:............................................ <br /> Disposal Field (Specify Reqvirements) <br /> . ......._.........------.............. <br /> .................... .. <br /> _ ..--.-•--......-- ---------------------- <br /> (Draw existing and required addition on reverse side) <br /> fz, 1 hereby certify that t have prepared this app <br /> lication.iand that the work will be done in accordance with San Joaquin <br /> e. County Ordinances, State Laws, and Rulesand Regulations of the Son Jaaquin Local Health District. Home owner or Ilien� <br /> +F sed agents signature certifies the following: r <br /> "i certify that in the performance of the work for which this permit is Issued, I shall not employ an I <br /> ' P P Y Y Person in such manner <br /> as to becom su ect to Workman's Compensatio law <br /> of California." <br /> a, `� <br /> I Signed .... t..C. ......._ <br /> �f•;:, s ner <br /> By----- ..............................................................................•--- <br /> jitle ................. <br /> ry <br /> (if other than owner) .............. . <br /> ;.= <br /> rolk D PARTMENT USE-ONLY <br /> APPLICATION ACCEPTED BY....... ..t... ........ ►- <br /> DATE -..Z--: .!• ,.--2-)._..--.... <br /> r• BUILDING PERMIT ISSUED..............................................;:... <br /> DATE....................... ........ADDITIONAL COMMENTS....... . <br /> .......................:... <br /> •�T..40 .................. ............................................ <br /> ...................................................... ... ._ ..........Z •�.` -- - ..... ............................................................... <br /> ........................................................ <br /> Final Inspection b - - • <br /> P r ,.{..... —7e5 <br /> � . ............ ... ...._ ._._.Date _..�_.....-�._..._........ <br /> SAN JOAQUIN LOCAL -HEALTH DISTRICT I <br /> E.H.13 24 1.•66 Rev. 5M <br /> � .ta. 7/723 .14 <br />