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+� VOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 3,- ----- . --��............ <br /> No <br /> _..........:....................:........................_ <br /> (Complete in Triplicate) <br /> r flats Issued - <br /> ............................ .....:.....:.:............. . <br /> This Permit Expires 7 Your From Date Issued <br /> Application is hereby made to the San Joaquin foto) Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> J <br /> Y <br /> JOB ...........�G....c�.fa�.------�1�.1.►!�....��1.�G�.... .......................CENSUS TRACT .-....._.. ................ . <br /> Owner's NameL7_ ......... <br /> ...................:..... shone �sr�J�.. ,l�i?. <br /> i Address .� ..._.. _ ._ l�rn_ ... . ... -.._.� ........_...~...TCity� -/Y.Ts`'l .. .. .f.... : ............ ...... <br /> . <br /> Contractor's Name .......4 _--_.License #01 `v �-�- Phone <br /> _e4- ................................. <br /> Installation will serve: Residence'O Apartment House 0 Commercial)]Troller Court ❑ <br /> _.2... I <br /> Motel Other........- --•--..._.9...... .._._ � 1 ` <br /> Number of living units:....(....... Number of bedrooms .._3..._GarbO a Grinder ............. Lot Size 'b��1........ .....• <br /> Water Supply: Public System and name . _...... .............. �! ...._................................... ...Private Q <br /> Character'of soil to a depth of 3 feet: Sand❑. Silt Q - Clay ❑ Peat Q Sandy loam Iff Clay Loam Q <br /> kHardpan 0 Adobe 0 fill Material Al ....... If yes,hype............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEIN INSTALLATION: (No septic tank or seepage pit,permitted if public sower is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK .. Size---_-.---_.••---.....' ....:. Liquid Depth................... <br /> ' { l � l <br /> i f <br /> k j <br /> Capacity—_ TYfm .... Material €4--- _--_- No. Compartments .......__............�.- <br /> ► Distance.,td nearest: Well ....................................Foundation ...................... Prop. Line ..... ............. <br /> LEAC14ING LINE [ J No. of )sites •.................... <br /> ... Length of each line_--- -------------_------ Total Length ........................._-.� <br /> 'Q` 1)ox' ` `:..�._ Type Filter Material :. ..D&pth Filter Material ..--- ...................... ..I <br /> f .' �,. ....... .• "" <br /> Distance to nearest: Well . Foundation ..__.._ Property Line <br /> ` ... Diameter � Number .. .....--. Rock Filled Yea No <br /> SEEPAGE PI ( J ) Depth .............. ❑ Qj< <br /> Water Table Depth ...•--•-•..................-------- ..... ••-..Rask Size ................................ i <br /> 4 <br /> Distance to nearest: Well ........................................Foundation .................... PropJ Lure .............,,.......� <br /> REPAIR/ADDITION IPrev. Sanitation Permit. —. =-...... . �_-Daj .._......_-•........:........:.....) <br /> i <br /> -•-• .............`= ---•----••----•--- .......................... _.....---...----- <br /> Septic Tank ;Specify,Requirements)-_'--.. F -• <br /> Disposal Field ,ISpectfy_Requiremerits� -•�`=----. . .�.t.��.----- •!_q.�..-------- -- ............ ..��-------- <br /> ----- I---'-------_------- `..-. _.. . _ - - -----------• .......... . ...........-_.....:---......:...:_....... I ...--......_.......-... <br /> F rF.-• = -{DramV-existing ani# rji i61 red addition on reverse side) f <br /> I hereby certify that-1-have prepardd-title application a. d that at she work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulati9�s of the San Joaquin local Real&District. Homo owner or licen- <br /> sed agents si§naiune certifies the following: = <br /> "I certify that'ii the performance of the work for'which this permit is Issued, 1 shall not employ any person in such manner <br /> as to become sub ect man's CompensatiotiJldyrs of California." <br /> _ . ...;�,.., ..��� �/.........................................._._ Owner <br /> Signed _. ,. <br /> tle <br /> ______.(if._other,than_ow.nerl - __ <br /> FOVDEOARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --.fi1 -- .-- .. .- _ -•- - --------•- M------------------------DATE ._ s_7_...-•---_..r_---__: <br /> BUILDING PERMIT ISSUED --------- ----------------------------------- ----------------------- !.....................---DATE --- .................................. <br /> ADDITIONAL COMMENTS --------•---_- ----------------------------------------- ..... •--- ---------------------------•---- ....•••--• ........................... <br /> I ---------------- ---•---•--•--....-•--....-•---...-........................................................,. .. <br /> ' . . •--• <br /> .................4........-----.._........ .-• -------- •.................................----------- ------ ... ....----.... --..._...---•-•------....----•--- ..... <br /> ................I-------------•---------- _.... <br /> �p -7 <br /> Final Inspection b �!r/(\ ................•---....------•---- M ._Date ..1�.....�.-./,�...._....--._---- <br /> p Y <br /> EH 13 24 1-68 1tev• � SAN .IO QUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> EI <br />