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FOR OFFICE USE: � 7 <br /> APPLICATION FOR SANITATION PE MIT <br /> q-4 <br /> .. <br /> (Complete in Triplicate) Permit No. .?..3... <br /> .................................... This Permit Expires 1 Year From Date Issued Date Issued ...7'.3667 <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 compliancewithCounty Ordinance No.549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION °T .� .--`A�!..alt'/?.� 1_ •...1 1,P..> .._...G�V .:...CENSUS TRACT ..... ............•-...- <br /> Owner's Name .... ........... ..........--•-•--••........................Phone .................................... <br /> Address0.0.......KA.S.. .gey..R-d.................................. City ..�'Y � id-...---.............................................. <br /> Contractor's Name . �►�. --_�? d `� C2.,lh....................License #�66 1�� •• Phone S'A 3T y' f <br /> .1�. �. L. .5 ..--. .............................. <br /> Installation will serve: Residence 0a Apartment House 0 Commercial ❑Trailer Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:...../..... Number of bedrooms ._�........Garbage Grinder ............ Lot Size .. . ...?... . D O ................. <br /> Water Supply: Public System and name ......................•----•---......--------•-•-----.......--•---...............--•-......__..................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam J <br /> Hardpan ❑ Adobe❑ Fill Material ............ If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) fi <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size... .�X.. �.X_.rlr.............. Liquid Depth _.... .�.............. y <br /> Capacity J.i�k p.p...... Type&!g..CAS.TMaterial....G.D lV.Cc. No. Compartments <br /> Distance to nearest: Well ....................................Foundation ......iA.......... Prop. Line .....X/............ <br /> LEACHING LINE ( ] No. of Lines .....--.I.............. Length of each line.......9P.............. Total Length .................. <br /> 'D' Box ............ Type Filter Material ...Depth Filter Material ....... .P.'�......................... <br /> Distance to nearest: Well ........................ Foundation ......./.' .�........ Property Line .1.Q..`............... %.A <br /> SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes (3 No o L <br /> Water Table Depth ....................Rock Size r <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... ;P <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date 1 a <br /> SepticTank (Specify Requirements) ..........................--•---............---•--•-•--•---•--........................................•..................._................. b <br /> DisposalField (Specify Requirements) ...............................................................................................................................•..... <br /> ...........................•------•----•------................------•---•-......-----................------..................-----.................------•--•--..........._............ ................. <br /> •----------------------------------------•------•------.....----....--•---•---- ........................................................................................... .............................. <br /> C) <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 San 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 /> "1 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 4/V T A v Al { 0.1Y ................. Owner <br /> By .. ......................................... <br /> Title <br /> (If otheawe ) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .............................................. ....... :...... DATE ......2.C1� :..� .............. <br /> BUILDING PERMIT ISSUED ........DATE ...................... <br /> . .... .. ...._ <br /> ADDITIONAL COMMENTS ................................................ .. ............_............. <br /> ...........................•----........................................................................................................................................................---••............. <br /> .............................................................:...................................................................................................................................... <br /> -•..............•----...----•------•--............... ..............•...........-----..........................................eCT <br /> Final Inspection by: --••-•........................................................................................... 1h....Date ....... 2:. ..........SAN JOAQUIN LOCAL HEALTH DIST <br /> E. H.1.3 241Rev. 7/723 M <br />