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} &. <br /> F FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT _�s"o <br /> I Permit No. .. ................. <br /> (Complete in Triplicate) <br /> ................................................---- This Permit Expires 1 Year From Date Issued Date issued .' .............3 <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> • ••rte� <br /> JOB ADDRESS/LOCATION / . .__... .-..__ L./� 1 ............................CENSUS TRACT <br /> jam. .............................. <br /> -•vim'. --_--- <br /> Owner's Name ..._.... __ L...t__:.._ �. �''�. •-•-•-•-•................................r-•---••---._.......Phone ••--•-•-------- ............ <br /> Address ..........2 32_1----------•5------- ..........City ......IF&Cr.,.`................... .................................. <br /> Contractor's Name.f .1-•L...___-. .. -- License # _-__ .----------- Phone .............................. <br /> Ptd•ZOX �v,� ��RE-5-- <br /> Installation will serve-. es+ ence C,Apartment House❑ Commercial ❑Trailer Court �] <br /> Motel ❑Other-•------•------ -------------•-- -----•----- <br /> Number of living units:.....!_---- Number of bedrooms Zi Grinder,.-_�_ .S Lot Size -/g s* i4 ..._.._..... <br /> Water Supply: Public System and name ---------------•-•----=*'`••--.e---+1-••-••-•-••----•-- Private <br /> Character of soil to a depth of 3 feet: Sand D SjIt Q Y,`CIay ❑ PeatUi­ <br /> Sandy Loam fl - Clay-Loam 's <br /> Hardpan ❑ Adbbe fl Fill Material If yesr 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 seeppit permitted if public sewer is available within 200 feet,) /e (ry <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Size- 5X_4/69_X. Liquid Depth ..T___..............._. O z <br /> Capacity,&© ......... Type Pi EF-RS Material_CLIM-t3717—No.r Compartments ____ .._.?..... .. <br /> +stance to nearest: Well ........JV__:'#._____._._.Foundation Prop. Line ......> <br /> LEACHING LINE [ Nra. of Lines �y�� r <br /> �� •--�- ------------ Length of each Zine--- _...___•_•_-_-- Total Length l....��-----...... <br /> 'D' 1100. :._ Type Filter Material � 1:_Depth Filter Materiai ___,/-!_____________�._F�_-__-__ <br /> -- <br /> Distance to nearest: Well ___J _ :.___ Foundation -��_.::'�:_.._.._ Property Line r______________.__ <br /> SEEPAGE PIT [ ] Depth ____ .......... Diameter ................ Number ...........y_.............._ Rock Filled Yes ❑'- No i0 <br /> Water Table Depth ________ _______ _._.-_Rock Size:........ ....................... <br /> DistakEe to neare-sf-,Wdll._-�""�__7----`_-"'TFaur�dti8r5'-_"""'":._.._ Prap.�4line _______.____.__.-_ <br /> REPAIR/ADDITION(Pre-v,-Sanitation Permit# _______________._..._..__._.-___._.._._.____.Date _.______` ....... •!)� <br /> Septic Tank (Specify Requirements) ..._.. = :.._.: •--•-----•• - ,... ...`:--•-•------------- <br /> Disposal Field { pecify Requirements) -•_- ......-............. ------------ --- -•------•--•--- ......... a - - .............................. -- <br /> t --- ------------------•--•--•-•--------••--•-•-----•-•-•--••---•-•----------- ;� <br /> --••------------------------•--::c x---_ .----•: -•-••••----••••---.-- --•--..__.�...._ <br /> ...s. -7--------„ ..�,....,.z.-�„�..... �......,-• �....,.r,.:..- a �'�. <br /> (Draw existing and required addition on reverse side) �}` -�, <br /> I hereby certify thatt I have prepared this application and that.the work will be done in accordance with Son Joaquin <br /> County Ordinances, (State+Laws, and Rules and Regulations of 1is;San Joaquin Local Health Distrito Home owner or Ilcett- <br /> sed agents signatvret cerfifies•the following:---- ="_-=•T - `- ,,�,.,,.�, _, I <br /> "I certify in th T e ce of the work for which this permit is issued, 1 shall not employ•`bny perso�M such manner <br /> as to come sub t� or an's Compensation laws of California." <br /> {{ tt s } <br /> 'SignI r wner .. ! ! <br /> e •--`O <br /> BY ---------------_-_ -------------------------------- <br /> �' = = Title ---.- .._._._. _:.. T ---. .`..._ _.. <br /> k - <br /> (if other than owner). f o <br /> iQ <br /> i FOR DEPAitTMENT_USE ONLY <br /> APPLICATION ACCEPTED.�•B*— t -rQ=. AI•T= '•���--�•:f <br /> ,. ...... <br /> BUILDING PERMIT ISSUED "-`- ' `" -^--_._._._. __. <br /> ._..._._. ---__ . _DATE` <br /> ADDITIONAL COMMENTS <br /> ............................. •-••••••.........................•----•-----•--- ---------._..._'_................!•._.......--.... <br /> -•---•-------------•--------------• - - ---- -•-•-- - ---- ---•-•---•--•------••-----•-..............--•- - ---•-•........ <br /> \ , <br /> - • -•- <br /> w <br /> Final nspectioo_ ..... ...........--------.--_-,.,.Date_ �- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> + E. H. 9 1-'68 Rev. 5M <br />