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FOR OFFICE USE: y,�ooh LlZ ( 1 <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------- - •--------------- <br /> (Complete in Triplicate) Permit No. . :3 .�_ Z <br /> -.____ ------ t This Permit Expires 1 Year From Date Issued Date Issued 3....z z <br /> Application is hereby made to the San oaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in mpliance with County Ordinance No. 549 and existing Rules and.Reov lotions: <br /> JOB ADDRESS/LOCATION ._ 4mT'__y P!4---- Ic Lytr-.--CENSUS TRACT .,........................ <br /> Owner's Name ..-,qO� 3� ��? 2 - ---- - ---_- ---- ............. <br /> Address �COOd ---------------• - i <br /> _7),.el_ ..................... --....-•••--•. ... <br /> d L <br /> Contractor's Name /V License #/6 �-✓�.g��--- Phone Jf_ .%_". �2�` <br /> Installation will serve: Residence OrApartment House❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other --------------------------•--•-------------- <br /> Number of living units:__.---_ Number of bedrooms ......:...Garbage Grinder ------------ Lot Size _._J`_-^a.'x..�' 4...............• <br /> Water Supply: Public System and name ---_-_-5- -- R, -- ............... _...Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam NJ Clay Loam❑ <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.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer-.is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:Do Size.....` _ _✓_Ie _ ..Ir-------------- Liquid Depth ....Y`.._._.._. ,..._ <br /> Capacity 1-•Z_0(2___.._ Type & _"57M* aterial____- No. Compartments ... ?`.......... <br /> Distance to nearest: Well -------V-4______________________Foundation -----10............ Prop. Line ..�✓r.:.,.... . U <br /> LEACHING LINE No. of Lines -___-__�_ .------------ Length of each line--------4.0. _.._ Total Length ---L9.1......... <br /> r?O .r <br /> 'D' Box ....�.____ Type Filter Material f�._R+�_C�Depth :Filter Material ............................................ <br /> Distance to nearest: Well ----_ ,�_�_-----__-:-_ Foundation _____________ Property Line ..20................ <br /> SEEPAGE PIT Depth --------------------------------p ._ ._.____ Diameter ________________ Number ___ __ _--- .----------_-. Rock Filled Yes E] No <br /> [ 1 <br /> Water Table Depth ................................................Rock Size ................................. <br /> Distance to nearest: Well ........................................Foundation .--------- --------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ............................... <br /> SepticTank (Specify Requirements) ------------------------------------•--•-------•---•-•----•--------•--•-------•--------------•--------------.---,,.-•--------_--.------•---- <br /> Disposal Field (Specify Requirements) ------------ --------------•-----------------------------------•-------- <br /> ----------------------------------------------------------------------------------------------------------------------------- ----- •--•----------•-•-•-••-•---•-----•---•--••--•----•-•••-•--•-------•- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regu'ations of the San Joaquinlocal 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. _ N?' o 5�--------------- ....................... Owner <br /> ------------ Title <br /> (If of a r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------------------------------------------------------------------• ................. DATE ........................................... <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------------------- ---------------_---..............DATE ........................................... <br /> ADDITIONALCOMMENTS -------------------------------•---•............................................................................................... -------- ----------------•- <br /> ----------------------------------------------------------------------------------------• -------- ----- --- -••---------------•-- --•--------------------------•--•••---•--•-•--•-•-----•-•••------•---• <br /> ------------- - --------------------- ---------------------------------------------- -------------•------------------- <br /> ----- - ----------- --------------- •------- ............. -----_---1 -� <br /> - -•- <br /> Final Inspection by: . .----------- ---------------------------- ---------------------------•--•- - --- ----Date �-•-........ <br /> SAN JOAQUIN LOCAL H A H DISTRICT <br /> E. H. 9 1-'68 Rev. 5M C V_6�_ <br />