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FOR OFFICE USE: <br /> k��PLICATION FOR SANITATION PERMIT <br /> Permit No: .7e? <br /> .......... ----•---------• - ................. (Complete in Triplicate) <br /> _.---•............... Date Issued <br /> ...............- - �( 7C� <br /> r <br /> This Permit Expires I Year From Hate Issued r <br /> Application is hereby maje to the San Joaquin Local Health District for a permit to 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 /> • 11 <br /> " ..............CENSUS TRACT _.._--._........... ... <br /> JOB ADDRESS/LOCATION __.__�9a'6- �'' �O1Zy ]3T�V6_•. <br /> Owner's Name -I MPS. $i7nil@ Fe........... -•-------,. ............. =-•-----••-..........Phone <br /> Address ---- II Vie---- ...................................•--•---•--•City .:`.�r. e�-_-------..... - ..:... <br /> 4 <br /> Phone .._ <br /> Contractor's Name ....Pa.mQ1�1S _-- :1=b3Dg-- £4r ........License # .--.9` 5. °� <br /> Installation will serve: Residence[(Apartment House'❑ Commercial❑Trailer Court <br /> Motel ❑Other. ..................................... 5GV <br /> of living units:..;_I.1_-_-__ Number of bedrooms .__.._�__ garbage Grinder ............ Lot Size _.__:_........----------------••••••-•-••••• <br /> t Water Supply: Public System and name -___-_. Private <br /> — ---••- <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay [] Peat❑ Sandy Loam ❑ Clay Loam <br /> 11 Hardpan 0 Adobe-C] Fill Material ............ If yes,type------------------ ------ j <br /> (PI-ot plan, showing size�of lot,,Location of system in relation to-wells, verse <br /> verse side.) 'd <br /> NEW INSTALILATIOK. ­(No- tank or seepage pit permitted if public sewer is available within 200 feet,) i <br /> PACKAGE TREATMENT .[;-.1 SEPTIC TANK,[ ] Size_.,.-;-_--- LiquidDepth .. <br /> .. Material*. :_____.. No., Compartments ____. _ __ _._.... /!` <br /> -�-- <br /> Distance to nearestWell ______________5-...................Foundation <br /> -- ----•-••-:;---. Prop. Line -----_•---:_.:..----•- <br /> _._._ Total Length <br /> LEACHING LINE; ! [ ] No, of Lines ...................... Length•of each line--••--------•--------•- .............................. <br /> �' Box .---.....--- Type Filter Material:......... .........Depth Filter Material.............••-----•-••---------- =____." <br /> _ <br /> 4 - - - _ t Pio e` 'Lme'_- -- <br /> istance to nearest: Well _____________________•__ Foundation ,F'------ P rtY '" <br /> , <br /> Depth ---- ------ - - --- Diameter _-----_-------- Number ..__._.......'-.-•---...•--•-- Rock Filled Yes ❑ No iQ <br /> SEEPAGE PIT [`] r p i . <br /> Water Table Depth -_ ---- ......... Size --___--•-••------- <br /> Distance to nearest; Well --------- ,----,---•----I.........Foundation ___-_----_•-•-- --- Prop. Line ......... <br /> ' Date ..Y"•--'-•----•"---------- <br /> -•) <br /> REPAIR/AD1�IT10N(Prev.gSanitation Permit�' _••--------•--_•----•------------------• - <br /> Septic Tonk ISpecify R$quirements) -----•--•--------------------------------------------------------•--------------_-•---•----------; ...._ --••-- <br /> Disposal Field (Specify Requirements) 100 lin-- -• _,.2 ..Viae---ZeaEl?:A9..-d <br /> .-•-------...--• <br /> }38 qF <br /> i <br /> hI (Draw existing and required addition on reverse side) l i <br /> I hereby certify that I hlave 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: I t <br /> "1-certify that in the"psrfbrrna o t work forwhiih•this permit•is isstiiad, 1 shall'not employ any parson in'such mi nner ` <br /> as to become subject to GYor man's Co ens n of lifor ia." <br /> Signed ---PAUMMT-"------ -- ------ -- . ` <br /> By ------•--••- <br /> itle ......Na.mg_l"................................... <br /> . <br /> (If other than own ' <br /> FOR DEP Ati ENT USE.ONLY <br /> APPLICATION ACCEPTED BY _------•----------- -------==--------- ------ 1 1,•-• DATE __. �'�G-ju <br /> BUILDING PERMIT ISSUED ......_-------_--------- ---- DATE _.. - <br /> ADDITIONALCOMMENTS ........ --------------------------------------------------- ................... .... - = -•-•••----•--- <br /> .-------------- ------ - - _ - <br /> if 0 - - <br /> - ------- <br /> - - - <br /> I� a1_ ...D .... - .a - <br /> FinalInspection --•-- ...... .............•- -•--•--•--- - -•-------------- •-------------•------- <br /> SAN JOAQUIN LOCAL HEALTH DI RIOT <br /> E.H. 9 1-'68 Rev, 5M <br /> _ 4 <br />