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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> .................... 7�1 /a,z <br /> 4 (Complete i nTriplicatel Permit No. ..................... <br /> Date Issued/�-7-. 751 <br /> -.......•............ ............ . .............. ..... � This Permit 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 County/Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION . .. y -. .,.,.1 ............ :`: <br /> CENSUS TRACT <br /> Owner's Name ..... Z <br /> ........... ....... -_._.... 'C'L . ..__ .. .._...._... <br /> y`� . . .... .. ........... <br /> Phone � ... ­ <br /> Address <br /> s...- ...AQA.1. ..._.. .. .. (Ji. B.. ••-•----- •- <br /> CitY // tl. -• <br /> Contractor's Name ---•- . --- -------- --------License #�y .._ .. Phon �-w.- �7---[ n <br /> Installation will serve: Residence Apartment House C] Commercial []Trailer Court '❑ v 1 <br /> k tel ❑ �._. <br /> Number of living units:......... Number of bedrooms ._ Garbage Gander.: .__,.... jo Size ....�-c.1r�?~.s................. <br /> Water Supply; Public System and 41 e�_.. . <br /> ......_ .. Private [] <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe [' �t l Material ------- _ <br /> If yes, type .___..---__1.._._.... ... <br /> (Plot Ian, showi......_n ''_rlos. _�� <br /> p g j3ixe �oft, location of system in relation to wells, build?ngs, etc. must be placed on reverse side.) � <br /> NEW INSTALLATION: (NN e`' I <br /> o septic�tasnk,or seepa9epit:permitted-if°pUb'iic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-T j T Size..........................................--__-. Liquid Depth --..--.............. <br /> Capacity 1jT Y pe -----...— Material.------ -- No. Compartments ................ <br /> 'Distance jo nearest. Well ----------------- <br /> Foundation ...................... Prop. line -------.__........... <br /> k . <br /> LEACHING LINE -UP No.Nof Lines� -- .- � g <br /> L. n th of-each Iine - .--•.. Total Length ............................ <br /> 'D' Box _._ Type Filer Material Depth Filter Material .... .............................. <br /> Distance to nearest: Well -------- -------------- Foundation Property Line ........................ <br /> SEEPAGE PIT [ } Depth .. . <br /> ]__ -- Diaeter ................ Number --- Rock Filled Yes ❑ No Q <br /> Water Ta'bil Depth j ---Rock Size ... ............... <br /> Distance to nearest: Welt ...............•------------------------Foundation _........ -_. ....... Prop. Line .............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----�-- ----- Date --_.............. .... <br /> f Septic Tank (Specify Requirements) .-_...._.._ <br /> ...._.. . ....... ..... .. <br /> Disposal Field (Specify Requirements} ---.-__ <br /> ............ ....................... ...... .... . .... .. .....� <br /> ................. . .................. .... ...... _ <br /> —----- <br /> - --------- ............ . . .............. <br /> (Drdwexisting and required addition-on`reverse side} <br /> I hereby certify that I have prepared this application and that the work will be�done.in accordance with Son Joaquin <br /> County Ordinances, State laws, and Rules andlRegulations of the San Joaquin Local kaalth District. dome owner or licen- <br /> i sed agents signature certifies the following: Tvj <br /> "I certifythat in the the! <br /> work performance of thework For which this permit is issuedp I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed . ._ . ..._.-.. -- ----------- Owner <br /> BY Title <br /> r........... ...... ..................... <br /> r (If other t owner) <br /> i <br /> FOR DEPARTMENT USE ONLY. <br /> I � - DATE . <br /> f APPLICATION ACCEPTED BYE-& �........ .. ....:.. ..r. i . - <br /> ...._... <br /> BUILDING PERMIT ISSUED __.._- ..............DATE <br /> ADDITIONAL COMMENTS ..............._.:_- .... <br /> � ---- t. <br /> ---- <br /> ----------------- <br /> ....................................... -- .._...... <br /> : ..... _.._'_.........._. <br /> .. - <br /> --. . ._. .... .. <br /> t. .__.... . -------------------------- <br /> Final Inspection by: ...... ..... .....• --••--- ��' , . ,, - ---------Date.--.-- .-- --_-- <br /> ,` SAN:JOAQUIN CAL_ HEALTH DISTRICT. <br /> } E. H. 1-3 241-'b8 Rev- SM r u <br />