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,FOR OFFICE USE: <br /> 1ao .2 <br /> APPLICA _ R SANITATION PERMIT 95 i a <br /> J <br /> Permit Na(Complete in Triplicotel <br /> ---. ------ Date Issued....................................... This Permit Expires t Year From Date Issued <br /> Application is hereby made to the San Joaquin Locai,Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regutationss <br /> JOB ADDRESS/LOCATION .. U...I�.�_._. 4sSC?f.T�c�.G .D�I Jai.u.�utlPSUs TRACT .......................... <br /> Owner's Name ..We _yv_e...... ................................-...........................Phone— <br /> Address . . ......... ... .......... ...... .... ••----•---.......... •...................... City ........................ ............ <br /> . ..... <br /> Contractor's Nome . ".1V�� P-J�-l�/.......Gt 1I�1. t A./�L.....Llcense ........................ Phone ...................... <br /> Installation will serve: Residence); 'Apartrnent Houseo Commercial OTrailer Court 0 <br /> Motel 0 Other ...................................... <br /> Number of living units:.-/ Number of bedrooms,.?.......Garbage Grinder ............ lot Size ............................................ <br /> Water Supply: Public System and name ----------------- .Privatex <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[] Clay j] Peat 0 Sandy Loam 0 Clay Loam M <br /> Hardpan W Adobe-p Fill Materlol ............ If yes,type ............... ............ <br /> €Plot plan, showing size of lot, location of system In relation to watts, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size...... ....p..I........................ Liquid Depth .. ..y............... <br /> - Capacity ,_d___-_-___ Type:.A�:� Material._? No. Compartments '� <br /> Distance to nearest: Well 1561........................Foundation /F ..... Prop. Line <br /> LEACHING LINE No. of Lines O y <br /> [ l --.g-------------- Length of each line.--- C2_................ Total length ---.................. <br /> 'D' Box ------------ Type filter Material ....................Depth .Filter Material ..................I......................... <br /> -- __Distance to nearest: Well _.� f............. Foundation ...-- --- - ---------. Property Line ....----- •--.......... <br /> SEEPAGE PIT [ l Depth .49�,...._.... Diameter c3............ Number ------ - ------------------ Rock Filled Yes� No �] <br /> Water Table Depth ..................... ......................._Rock Size ............. .........--••p <br /> /- <br /> Distance to nearest: Well ..1.5-0............................Foundation ._..._ ` .-- Pro . Line ---_-------.- --_-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _..---...... ---------- - ------ Date ..................................) . <br /> SepticTank (Specify Requirements) -------------------...-•----------....................................--•--•---...._...--••--••---...--------......I.....-•----......---....... <br /> Disposal Field (Specify Requirements) ...___----------------------------------------------------------------------------------- - .--------_---_ <br /> ...---------------------------------------------------.--------- -------------------------------------....._.----------------------------------------------------------------------------------------- <br /> ---------------------------------- -------------------------------------------------------.............. •--•--------•-•---•----••-----------------------.-------------.-................ <br /> (Draw existing 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 and Regulations 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's Compensation laws of California." <br /> Signed By fZ - Owner <br /> :tie --------------------------_ ------ .......--- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- ------------- DATE . .« ./b .. ......-_..: <br /> BUILDING PERMIT ISSUED _.... - --- - --- <br /> ADi71TIONAI COMMENTS/D.?� i .6_ -- /__-�- .----...._....... <br /> _ ._... <br /> • - <br /> - -------------------------- - . .......el ...--••--. ..............._-.------•-------...._._.. ...._...------- <br /> ------------------- ,� ......------ ---...----- ' ......----..---// ...r, •-•-------......... <br /> -. -. . <br /> Fina Inspection by f.�ln..................... ...---.....----.....-•-... Date ....... .... <br /> ...-------• •--•----•----------------------- <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HIEALTH DISTRICT 8/7h 3M <br />