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FOR OFFICE;USE: <br /> t� APPLICATION FOR SANITATION PERMIT <br /> ...................... .........{.V_"O,. - I�7 <br /> (Complete in Triplicate) Permit No. ...........__..._.... <br /> Date Issued -3 •- 7S <br /> -- this Pen"It Expires 1 Year From Date Issued - <br /> Application is hereby made 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 my Ordinance No. 549 anWex ting Rules and Regulations: <br /> JQB ADDRfSS/tO91Q ON .-.-_- _ •� . .1__C ,2: - CENSllS TRACT .... ........ <br /> I Owner's Name _ N..>'....._W ..ij_ A ...e . .,. ".Phone ........ - <br /> Address ........... ....�_... ... <br /> . _ .. ._....._, . . _ city 3 c-r � •�.J <br /> Contractor's Name 7' .._..... .............. Phone License ' �J <br /> .......__ ....... ............J.. . ..,........._.._........... <br /> Installation will serve: Residence 011cp-artment House Commercial oTraller.Court 0 <br /> Motel []Other......................_..................... <br /> Number of living units ....... Number of bedrooms __.,-3_.Garboge Grinder f f.C::.. Lot Size / .G.! .�:...�Q ?4S._..... <br /> Water Supply. Public System and name / y...........................private <br /> R <br /> Character of soil to a depth of 3 feet: Sand o Sift Q CIaY ❑ Peat[] Sandy Loam ❑ Clay Loam o <br /> Hardpan❑ Adobe I--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 slde.11114 <br /> NEW INSTALLATION: No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT .[] SEPTIC TANK J l Size-------------------------.---------- ......_.... Liquid Depth ........... O <br /> Capacity .................... Type ..............__-__. i'Material -------- No. Compartments ...................... <br /> Distance.to nearest: Well. .............-------...............Foundation --------- ----- Prop. Line ..............._...... <br /> LEACHING LINE f No. of lines Length of each line......... .................. Total Length .............. <br /> 'D' Box ............ Type Filter Material .................:..Depth Fifter Material ................... <br /> Distance: to nearest: Well ......................_. Foundation ................ ....... Property Line <br /> SEEPAGE PIT [ ] Depth -----------•--•-_--- Diameter ................ Number .................-------.... Rock Filled Yes Q No iD <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) . xg <br /> Disposal Field (Specify Requirements) <br /> ...._. . ....................• •-•-••----••-•---- .............. ...................-.......... <br /> .............. .::_..................................___ <br /> (Draw existing and required addItlon on reverse side) <br /> I hereby certify that 1 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. Rome owner or Ilcew <br /> sed agents signature certifies the following: <br /> "l certify that in the performance of the work for which,this•permit is Issued, I shall net employ any person in such manner II <br /> as to become subject to Workman's Compensation laws of California.' <br /> Signed ...........:..:......... --------------------------------------- Owner <br /> Owner <br /> - ..Z`S _-----------_- ---- Title - O.'Z�_ ... <br /> (if of an owner) <br /> i <br /> FOR DEPARTMENT USE ONLY -. <br /> APPLICATION ACCEPTED BY .__., J <br /> BUILDING PERMIT ISSUED <br /> . _. ... ....: .......-••:•-..-, DATE ... ,:"- ,,5. ; <br /> �� . <br /> ---.-----...................... ............... _....DATE .........--............--• ......----•-... <br /> ADDITIONAL COMMENTS _...__._..... r <br /> --•- ------------­.......­___......................... .........•...-............._......_... ....... <br /> --._......._.........•.-.•. <br /> .............i _ _ •. ..---.-....- ....---- - ........ .. .... -•--• <br /> •... --•---•-----*............ <br /> ............... ------------------ <br /> Z <br /> .Fina! Inspection by. ........•.-..- <br /> .. <br /> I} <br /> ....... -. ��_ DateEH - .;... '' <br /> 13 2 1'6 °• 5mSAN JOAQUIN LOCAL HEAytiH DISTRICT <br /> 8/74 <br /> < I <br />