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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT L <br /> Permit No. ..................... <br /> 4.................................... I� � (Complete in Triplicate) <br /> ................................. . <br /> Date Issued <br /> -•• This Permit Expires 1 Year From Date Issued <br /> .Application is hereby mode! <br /> 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 /> .. <br /> L CENSUS TRACT <br /> JOB ADDRESS/LOCATION {kI_.d .ZY..__. '... e ... � ...:.. <br /> R. _. . .. <br /> Owner's Name .a:- <br /> ....-Phon .. <br /> ' _ I �:_V-arm' ....... <br /> .. - •-••:--. city ....... <br /> Address _ _ ---- - 3 <br /> f - one . <br /> Contractor's Name -. j B <br /> .....•...............License #pZs7__ - �'_ Ph <br /> Installation will serve. Residence R-Apartment House'❑ Commercial ❑Trailer Court ] "- <br /> ' Motel ❑Other .:................................. <br /> Number of living units------ '_.--- Number of.bedrooms _-..____.Garbage.Grinder .__._.____._ Lot Size .. ,._. ...........-•-•••• ••� <br /> _ ._..... •_..Private ® Q <br /> Water Supply: Public System and name.--.-._--•__•---------•--------------.---------• <br /> I - <br /> Character of soil to a dept ii�of 3 feet: Sand 1M Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ <br /> Hardpan [3 Adobe C] Fill Material . .......... If yes,type ---....----•---.....---••--- <br /> (Plot plan, showing- size if lot, location of-;system in relation to wells, buildings, etc. must be placed on reverse: side.) <br /> • is _ blic sewer is available within 200 feet,) <br /> NEW INSTALLATION: {No septic tank or, seepage pit permitted if pu t <br /> PACKAGE TREATMENT ( ]� SEPTIC TANK ] S� t'---�-- - -••---.....•.:........... <br /> liquid Depth ..1;�.g--------•-...---- <br /> • ' 4 <br /> Capacity .'.910-G.. Type .41prc ......... Material.........:........... <br /> Na. Compartments �............... <br /> n <br /> I Prop. Line .. ... <br /> ' Distance to nearest: Well .......5a­ .......—Foundation .._.�.......-_-.. - <br /> i <br /> LEACHING LINE No of Lines -Iter Materialof each line.-____. 1�. Total length 4....__._............ <br /> a t g rI <br /> 'D�Ni`Boxl.�. c. Type F' - ?R.r-Depth Filter Mateslal �._4................. .............. <br /> D tance to nearest: Well .. _-------•---= ... Foundation _.�-�.P_...........:... Property Line sa ---:•- •:.:..:•' <br /> Depth C Diameter _ J.` �.'_' Number :...�...:........... ...• Rack Filled Yes <br /> i <br /> SEEPAGE PIT [ ) P �..--•- <br /> . o <br /> Ater Table Depth ...................................-•-...----....Rock Size../0---------------- <br /> I <br /> -------—--- _ f <br /> Distance to nearest: Well ...L. ... .- . <br /> .Foundation ` } ........ Prop., Line .�� .............. <br /> ill <br /> REPAIR/ADDITION(Prev. Sbnitation Permit�# Date ...................... ............ <br /> -- .. .. ............................------------------ <br /> Septic Tank (Specify Requirements) ................. ..._ - .......� <br /> Disposal. Field (SpecifyiRequirements) ...... --••- --_ _ _ ••----------- <br /> 4 i� • .........................................................................................................................•.___._.__-_...___.__. ....... <br /> __ <br /> _______ ______________________________ <br /> x...... <br /> _ _I�I_ ____ ..... _ ______ g ____ _ _ __._..._...___ _.._____.____....______.._____....-.._.._._.......___..._._...._.___.. <br /> - __-- _ --­x: (Draw existinand required addition on reverse side) <br /> I hereby certify that I ha, e prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, StatefLaws, and Rules and Reguiations.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' Co pensation laws of California." <br /> Signed ._ ._ .. °t-------------•. ..................... Owner <br /> �, Title <br /> ................................ <br /> (If other than owner) <br /> F EPARTMENT USE ONLY <br /> - ^.2.* <br /> APPLICATION ACCEPTEDI1 BY ...... ,� -.--------.--- -...---••........................ . DATE _._.. ----_ .._._.__.... <br /> BUILDING PERMIT ISSUED - ......----••---•-DATE ... = <br /> ADDITIONALCOMMENTS'•-----.............. ----....------._........•-----....---...-----....-.._. , --..._...----------•---••--•-----...._.._----......... <br /> �ip ...----`---•.-----•-•--•-`•--:.....-••--•........................:••--- •--•---••-......... <br /> .........................................IIS.. � ........... , <br /> --------------_--------------.--- •--•----...---......--:_• ............... ................................---- -- <br /> dU � � ---•... <br /> i.- :_ ... :.... <br /> Final Inspection by: �� A.. 1..9` _...........•.......... ate .... ..... ..... •••- <br /> f SAN JOAQUIN LOCAL' HEALTH DISTRICT <br /> 7/723 ,14 <br /> c u 13 24 1_'ha 2.v. 5M <br />