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FOR OFFICE USE: 01
<br /> � w
<br /> 3 a AOLICATION FOR SANITATION PERMIT ,�,,3 —/uo 5
<br /> ...........................fi}, .......: '`` Peimit Nb. r�;..__._...
<br /> (Complete in Triplicate)
<br /> ........... pate issued
<br /> . ....... ..
<br /> . This permit Expires l 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 compilaned with County-Ordinance No.,5A9 and existing Rules and Regulations:
<br /> CENSUS TRACT ......-...................
<br /> J08 ADDRESS/LOCATION—J., _ lr"••J 1 .,...................
<br /> Owner's Name ly/�• 1".-•/ /� r................. ..............y.�.-•--......._.......Phone ...... '.
<br /> Address ..... ,,:� , .......1 ' .z7� .,,�.• ''�� ....,...»>..City .a ,✓, �i .�.........................e....
<br /> Contractor's Name ....,,�' "�1r" -. t� ✓' . ...:..........,....,.....,,......,.License # ..
<br /> Installation will serve: Residence Apartment House Commercia3 QTraller Court 0 i
<br /> Motel,Q Other ..._.......................................
<br /> 'I •- Garbage Grinder 1.'.!p. Lot Size ✓C��`�'!!�'! .................
<br /> Number of living units,.,./.-'I.... Number of-'bedrooms .. .....__.
<br /> ..
<br /> Water Supply: Public System'and name ........ ............................
<br /> .......................
<br /> Character of soil to a depth of 3 feet: Sand.'[J Silt[3 Cloy -Q,—.Peat p._ Sondy.Loam 0 Clay Loam_0
<br /> l� Hardpan [] AdabeFill Material _... if yes,type_...___......
<br /> ............
<br /> (Piot pion, showing size ofd;lot, location of. system in relation to wells, buildings, etc. must be placed am reverse side.{ j ,s
<br /> NEW INSTALLATION: (Nol'septic tank or seepage pit permitted if public sewer is available within 200 feet,) �•J�
<br /> PACKAGE TREATMENT ( � SEPTIC TANK T ) Size......................................... Liquid Depth .....,....._._
<br /> I -
<br /> No. Cornpartments'
<br /> 'fi• ';Capacity 'Mafierial..........__.. ......................
<br /> r ....._. Type .................... .._... ,
<br /> .Foundation . Prop. Line
<br /> . .x
<br /> Distance to nearest- Well ..................... .....................
<br /> EACHING LINE [ } No..of lines ..'.�°Length_ of each line............................ Total Length ...........................
<br /> D' Bax ..__....._..-�ype Filter Material �... :'Depth Fiifer Material ....................................
<br /> ..... .....
<br /> Distance to nearest, Well Foundrtion Property Line ........................
<br /> SEEPAGE Piz ( ; Depth ............. .p`.. Uiornster ...... Number ~""� .. stock Filled `les 0 No Q
<br /> Water Table Depth"?........... ........
<br /> .._..._..-•-•••...-•----.-Rock Size ...... ......../.. ..
<br /> Distance to nearest: Well ........................................Foundation .........._.._.._.._ >top. Line ...................
<br /> REPAIR/ADDITION(Prev. Sariitotion Permit# .... ....................................... Date .................................. _ )
<br /> Septic Tank {Specify Requirements} ............. .........._.._................. ...........i. /..� ,Y.._ !--......_.........._.
<br /> Disposal Field (Specify Requirements) ..+~x�'' r: .,,� , .• • ,.
<br /> !✓= - fr-.. . -" ,j "`
<br /> ..............................................................,......>.......... .........�. ._.......... - �-..........�......._.„..
<br /> ................._.....
<br /> ...Draw existing and required ad41tibn on reverse s+dey.............................:.....................
<br /> ............
<br /> I hereby ctartify that I have prepared this application and that!the work will be done in accordant* with San Joaquin
<br /> County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health Distrkt.Home owner or licern-
<br /> sed agents signature certifies the following: r ��
<br /> "I certify that in the performance of the work for which this permit is issued, I shall not +rsnpioy any parson in such rnannsr
<br /> as to become subject to Workman's Compensation laws of C�aliiornia."" j
<br /> Signed ..__ .. .............................� Ownert
<br /> f By......................... ,. i�,r �{+c�.........I............................ Title . + o... ......-.............._.....-.........
<br /> (if r than owner) y i
<br /> FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED By. .................................. ........................
<br /> DATE ..f . .. .. .............. i
<br /> S ...... .
<br /> BUILDING PERMIT ISSUED OAT .................' .
<br /> 4DDITIONAL COMMS ..,t V._ .lG `,c . .......... ............_..... �.. �......
<br /> ....................... ... . j.._......... _ ..._.._.. ... ................_._.............
<br /> ._.-.---.-.-.-...........
<br /> ..
<br /> .............................. . .. ..... ...
<br /> Final inspection by ... L '`""'.. ...............Date . 11� y7
<br /> _SAN JOAQUIN LL HEALTH DISTRICT
<br /> 7/723 ,4
<br /> r u 2.3 241.'t,8 Rev. 5M
<br />
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