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FOR OFFICE USE: <br /> APPLICATION <br /> FOR SANITAYION PERMIT <br /> s <br /> IComplete in`Triplicatel Permit No. ^. <br /> - t <br /> This permit Expires 1 Year Ecom Dawlssueel 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 O #Hance Na. 549 and existing Rules and Regulations: <br /> t Y <br /> JOB ADDRESS/LOCATION .. 16 e _ ' <br /> Q <br /> ` '. .. .....................CENSUS TRACT <br /> Owner's Name :. <br /> .-... y --- ... Phone � �/�. � .:..... <br /> ... . <br /> Address .7 C <br /> ity <br /> Contractor's Name ---- ... Q3~r!,J.._..• Phone ........ <br /> ••----• ----••-•--...License # �f: 3•- 46 <br /> e . ... .` ��7._.: <br /> Installation will serve: Residence Apartment House 0 Commercial E)Trailer Court-0 , <br /> Motel❑Other--...---•-••-----•....---...• .............. <br /> Number of living units:.----- ---- Number of bedrooms _..1�..._:`Garbage Grinder Lot Size ,�;�� <br /> Water Supply. Public System and name _ `'� - <br /> PP Y u " Private <br /> Character of soil to a depth of 3 feet:', Sond E] Silt o Clay,�[Q Peat Q Sand Loam Clay Loam [ <br /> Hardpan[j Adobe "Fill Material ............ If yes,type:.............. <br /> (Plot plan, showing size of lot, location of system In mlatiota,wells, buildings, etc.,must be placed on reverse side. <br /> NEW INSTALLATION: <br /> {No septic tank or seepage pit permitted-if public sewer is available Within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC-TANKO '-- <br /> - s � r <br /> _.. .-y r <br /> _ Size::• ---.�.�._.'�'�-__'r""""""'•......-•--- Liquid Depth <br /> f- --- : t . .........Capacity / TypeMaterial.. � No. Compartments . . <br /> Distance Vto neare' Well :?-d' ................Foundation _...�(i ............ Prop. Line .-sf..-..1....._... <br /> ., <br /> LEACHING LINE ( No. of Lines Length of each 'line.._._.. -_--- - r <br /> 0 <br /> ............. <br /> Box <br /> . ......... Total Length .-I r_L r <br /> D' .... Type Filter Material .L-_. _..._..__Depth .Filter Material /1P <br /> T� f­"'Distance to nearest: Well .._• �--f ....... Foundation ..-- 1..0.-r7'"----- Property Line l <br /> t- .. <br /> SEEPAGE PIT ' ` r `. .. <br /> Depth:----? _-..__•�Diameter-- 3 =-:__ Number --.._.. --. .. .. Rock Filled Yes No <br /> �jU <br /> Water Table Depth ...........Rock Size -7 f X I........ <br /> - <br /> Distance to nearest: Well .-------WK._ {- j' f <br /> -- •- -•...................Foundation ------.�....-•---- Prop. Line ........... <br /> REPAIR/ADDITION IPrev. Sanitation Permit s# --------.._.•_---. ..... Date <br /> Septic Tank (Specify Requirements) .................... <br /> Disposal Field (Specify Requirements) _........................_.-........... i <br /> !1 <br /> ------.----------- I <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 clone 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 /> "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> a <br /> Signed --- Owner <br /> By .... ...... ----------------------------------- ... Title <br /> _.CLAI# of than owner] <br /> I FOR DIEPARTM NT USE ONLY <br /> APPLICATION ACCEPTED BY.--.-.... �-..._. <br /> - --- .......... -------- DATE .�. a-)- 7. <br /> --------- <br /> BUILDING PERMIT ISSUED :.'------•---'-- ------------------� ©ATE - <br /> ----- ---- ------ ---- <br /> ADDIT <br /> IONAL COMMENTS --------------------------- - -- - •- •-•--<--.-,_. _.-.. <br /> -------�•••--------------•-------- <br /> -------------- .....-- j. -. - -.-...._ <br /> Final Inspection by: -...- -- _-- <br /> . . . ....... ..... = ------•----•--------------------- •-----•--•----.-Date <br /> EH J.3 2tt �-fit3 Ifev. ��-•�-�............. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M . <br />