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v FOR OFFICE USE: APPLICATION rOR `ANITATI4N PERMIT <br /> -------------3' --------------- Permit No- --------------------- <br /> (Complete in Triplicate) <br /> ----------------------------------- ------------- ------ p3 �3 <br /> Date Issued ___ ._"`______------ <br /> -------------------------------- <br /> ____. <br /> ------------------_--_----_---_------- -----_ This Permit Expires 1 Year From Date TIssedApplication is hereby made to the San Joaquin Local Health District for a perto construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION -- -------------4- /_.�---- l r - �v/��` CENSUS TRACT <br /> Owner's Name ----AIle --�-�-w ------- ------ -------- '--------------Phone <br /> Address -------S�/fxcc—--------------------------I- ---------------------------------------------- City �TG'�-�i ------------------------- ------- <br /> Contractor's Name -- <� ��_e-------<.4'P--------------- -----------License 0-7203------- Phone ----- <br /> Installation will serve: Residence ® Apartment House❑ Commercial []Trailer Court 0 <br /> Motel ❑ Other ------------------------------------------- <br /> Number of living units;---- ------ Number of bedrooms ___,Z-----Garbage Grinder __ G___ Lot Size __________________________________________ <br /> Water Supply: Public System and name ------------------------------------"--------------------------------------------------------------------------Private ❑ <br /> 2 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam :❑ <br /> Hardpan ❑ Adobe 'F--4 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__57,0.7 !_941------------------- Liquid Depth _41_-_-------_-------__ <br /> CapacityAW .1- Type /t T Material4GYN�41� No. Compartments P9_________________ <br /> Distance to nearest: Well —-----------------------Foundation _/0--------------- Prop. Line -_S_-!_____;___... <br /> LEACHING LINE Dd No. of Lines -------/--- -------- Length of each line-----/aO__`___._.____ Total Length r------------- <br /> 'D' Box N-12---- Type Filter Material IeAt- '(_----.Depth Filter Material -J-'V----_______________________________ <br /> Distance to nearest: Wellr_______ Foundation ---1.0___"_________ Property Line -.,Ir------_____________ <br /> SEEPAGE Pit [ Depth ---------- Diameter ------- Number ------1_______________.__ Rock Filled Yes j[l No .0 <br /> Water Table Depth ---- ____Rock Size-------------------------- �/ <br /> . �0 �/ <br /> Distance to nearest: Well __-.fir-__________________________Foundation __1_49-±_ __ Prop. Line ____I' ______.._... <br /> I REPAIR/ADDITION(Prev. Sanitation Permit# _________________________________________ __ Date ____________________._.___________) <br /> SepticTank (Specify Requirements) -------------------------------------------t------------- ----------------------------------------- ---....---..--------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- - ------------------------------------------------------------- ------------------------------------------------------------------------------------ -------------------- <br /> ---------------- <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 clone 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 subject to Workman's Compensation laws of California." <br /> Signed --------------------------------------- Owner <br /> Title --------------------- <br /> ---------------- <br /> (If other than -ow er) <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- ------------ <br /> --- -- -_W <br /> - -AAA ------------------------------------------------------- DATE ---- L-- 3= ----------------- <br /> BUILDINGPERMIT ISSUED ------- - - -.-- - - - -- ----------------------------------------------------------- DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----- -- --- ------ ----- - ------- ---------------------------------------------------------------------------------------- --------------------------- <br /> -------------- ---- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------ - ----- <br /> ---------------------------------------------------------------------------- ---------- -- - - -- <br /> Final Inspection by: ---------------------------------- --------------------------- ------------------------.Date ._.. --�q__ ,°r�--- -------- <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />