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FOR OFFICE'USE: '`�� <br /> APPLICATION FOR SANITATION. PERMIT <br /> •------•------- --------------------------- m <br /> - •. . <br /> (Complete In Triplicate) <br /> _ . _ <br /> Per it No �.... <br />................................I............:...._..._........:...._..._. 'his Permit Expires 1 Year From Datels�tted <br /> Doti Issuedd..21::7� <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 Ordinance No. 544 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION .....(9_/.. ......�......h 1 H'! �e - �L rt- . ..S o . ,., ....CENSUS TRACT <br /> fi <br /> Owner's Name ......---••.....................:.............................:................Phone .C?,.3.,/1.7s....--•- <br /> Address ........_ <br /> ... . _._. <br /> Contractor's Name .,�Gtrr.I.S..A.... .. d1� .............................License # r'�XY!� .X_... Phone _ ... <br /> Installation will serve: Residence��t House Commercial OTraller Court 0 y6 G <br /> Motel Q Other ............................................ <br /> Number of living units....1......Number'of'bedrooms -_3.__.-__Garbage Grinder lot Size <br /> Water Supply: Public System and name ....................•----..................----...:_-- .-----•....Private �}� <br /> -----------•................_._. <br /> Character of soil to a depth of 3 feet: Sand I Silt© � Clay_nr Peat(3 Sandy Loom Cl Clay Loom ❑ <br /> i <br /> Hardpan ❑ Adobe&Fill Msaterial ............ 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 fact) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ I Size................................................. Liquid Depth ..... ................ Da <br /> Capacity ... --_----•----- Type ...............1z... Material...................... No. Compartments ...................... <br /> Distance. to nearest: Well --------------...........:............Foundation ...................... Prop. Line ...................... , <br /> LEACHING LINE { J No. of Lines .........:..... Length of-each 'line..................... .. Total Length ............................ <br /> 'D' Box -------._.-__.Typo--Filter-Material ........_.....'.'_Depth .Filter Material-....:.............................._....__ <br /> Distance to nearest, Well ..........._.'...z... Foundation ........" . ......-:-Property Line ....................... <br /> SEEPAGE PIT { j • Depth Diameter ................'Numl;ar.......................... Rock Filled Yes C) No C(Q =` <br /> Water Table Depth ...............................................:Rock`Si e": ..:......: �. <br /> ! Distance to nearest: We11 ........................................Foundatlon Prop Line . <br /> REPAIR/ADDITION'(Prev.-Sanitation Permit#".........-.............. ....... Date '° ...I <br /> Septic Tank (Specify Requirements). . .` <br /> .....................�.... --------...------------------------------.....:_..........__... _r........... <br /> Disposal field (Specify Req.uirem'ents) ..... '=1� ..... ratty. _!.t?.. .......iF.... !�.:�.....11-1.X.ZSV.�1.f, <br /> ..,...................................... <br /> ............. ........... .. ..-------- ------ ------a_,__....._._:....................._.---------------•.,....-•--•-•------•-••----•-=--•-••---•••------••.......----•................... <br /> ...... <br /> (Draw existing and required addition on reverse side) _ :I <br /> I hereby certify that 1 have prepared thisaplication-and,that the. work will be,donR!in►acconlance .:crith San Joaquin +M <br /> County Ordinances, State Laws, and Rules and Regulations ."tithe San Joaqulq,Local Health�Dlslrict. 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 G <br /> as to become subject to Workman's Compensation laws of California." a <br /> Signed ------ ...... ----- --------••-----. Owner,, *: , <br /> BY --------------------........... litle ....... -- ._` . ' <br /> (If other than owner) <br /> _ FOR DEPARTMENT USE ONLY � <br /> APPLICATION ACCEPTED BY ........ .. .. ...................................................... DATE Z::` - <br /> BUILDING PERMIT ISSUED :...:._:.:............. - �•----•- ---- -------- ----- <br /> - --------- ....------. ---.DATE ..........---..............---------- . <br /> - ------ <br /> ADDITIONALCOMMENTS -------------------_ -•---•---............. ............... ..........................-........----------------------------------------------- <br /> ------ ----------------------------------------- '_..et-----... / ! ---------- <br /> ----------------------- <br /> _�" <br /> :_... T'R` ---� •--•.'- --�•-....-- •--------- ---------------------------------------------------- <br /> .........................:._.....��........�.......:�------=.........------------..........--------•---•-----------...........---------- --._ �.,.-. �............._. <br /> find! Inspection by. -...':-�1-- ------------- -Date _.A,..� .. .._......_....._ <br /> -- <br /> EH 13 24 1-613 lay. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />