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tl <br /> a <br /> a <br /> FOR OFFICE USES <br />-. .APPLICATION FOR SANITATION PERMIT <br /> s (Complete in Triplicate) <br /> Permit No. ..7q'..Z/_ <br />' Date Issued.,3'!�F_.7 <br /> This Permit Explroz I 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 heralrs <br /> described. This application is made in compliance with County Ordh once No. 549 and existing Rule* and Regukstk <br /> 1 JOB ADDRESS/LOC ...,.,. 2-. _ . E`.aw..�C�. .CENSUS TRACT <br /> Owner's Name %� uR.,�....4.C ..5tl .. ............... ...................................Phots.....».. ...»..... ___.. w <br /> Addre►a . .... ... . ... .. ..1 ''...._City ....... . .................._... <br /> Contractor's Nome .. :y_. rr--s.....� •- G......5.4 -^4+...license# ...�f�.3h~Phots ........... ' <br /> a Installation will serve: Residence❑Apartment House 1] Commercial❑Troller Court C3 <br /> Motel❑Other........:Sr4rl�. „ <br /> y Number of living units:.. "_-.. Number of bedrooms .--......Garbage Grinder lot Sir <br /> Water Supply, ('ublic system and name ...........................................................................»..........».................».PrlvaN <br /> t Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ 'Peat❑ Sandy Loam ❑ day Loom Q <br /> harc:pan Adobe ❑ Fill Materiol............If yes,type............................ . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ek. must be placed an rover" sic4j d1R <br /> NEW INSTALLATION: (No septic tank or we go pit permitted K blic sewer is available within 200 feet.) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK{►f ��''��''' SI2S.�F r.7—,,. <br /> �, I�:9�..X S ....... Liquid Depth .,y.�.... <br /> Capacity .12 f!.—...... Type�e.�::" s....... MafMiol...CAX . . zero. Campartmrnil Y <br />■ , Distance to nearest Well ......... �....................Foundation...... <br /> LEACHING LINE (!f No. of Lines ......../............. length of such line.......... � ..... Total Length ...Sd <br /> 'D' Box . Type Filter MaWla) .......F! .....Depth Filter Material ..... ........».. <br /> Distance to nearest, Well .....,..:S.!........... Fvundatlon .......G,Q„ Property tine <br /> SEEPAGE PIT (+j/ Depth ..... ?:.. Diameter �...... Number ......./.................. Rock Filled Yes Ll' No Q x <br /> Watnr Table Depth ............5.0.........» ...»..,Rock Sire <br /> Distance to nearest, Well ..............1. �?..�...........Fou ndotion .1AT.......... Prop. Line ....C_�. <br /> REPAIR/ADDITION(Prov. Sanitation Permit 0 ............................................ Doh ........ ...»......»»».....) <br /> Septic Tank (Specify Requirements) ...................................................................................................................._..... <br /> Disposal Field (Specify Requirements) _ ff >I <br /> ................... ......................................................................................................................................».................,......•............... {I I <br /> ( ..........................................,..,........... <br /> Draw existing and roquired addition on reverse aldol !' <br /> I hereby cWIfy that I have prepared this application And that.** work will be done In accordance with San Jeaqulrs <br /> County Ordinances, State Laws, and Rules and Reguicttions of the fan Joaquin Lead Health Distrld.Hance ewnw of Nem <br /> sed agents signature certifies the followings <br /> "I certify that in the performance of the work for which this permit Is kneed,I sW net ampley airy person M rids We" r <br /> as to become subject to Workman's Compensatlen laws of CaliferMa." <br /> .' Signed ............................ .l .....................- Owns►e <br /> By.....................................C..._z'r� r.`'(.... " - ` C,t,. J1tI•..t. <br /> z: (If other than owner) .......... ............. ......................................... <br /> 4 FOR DEPARTMENT USA ONLY <br /> APPLICATION ACCEPTED BY........................ ...................................».................................DATE..�-, I N'7.,.._.:..».».». <br /> 41 <br /> BUILDING PERMIT ISSUED ",DATE......... ................. <br /> ADDITIONAL COMMENTS ............................................................... <br /> ............................................. ..................................................................................................................................................... .» <br /> Finol.Inspettion.b...........��,R..�....... ......................................................................................'..............:i j:....................�....... <br /> Y �.� s: -.r-.c .............. .........................................................Dah'�........».... ...........»....... <br /> SAN JOAQUIN LOCA`KEALfH DISTRICT ' <br /> r. H.13 241.'68 Rev, SM 7/72 3 M <br />