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FOR OFFICE USE: <br /> APPLICATIONFOR - <br /> SANITATION PUMIT <br /> . - ,, lCornplete.in Triplicate) <br /> Permit Na. ..7•S`__..7.33 <br /> ` This Permit Expires 1 YFrom Date is issued <br /> ........... ...................... . ............. pes Year.... sated Date <br /> Application is hereby made to the San Joaquin focal Health Distfict.for a permit to construct and install the work herein <br /> described. This.application is made in compliafi+a with County Ordinance No. 549 and existing Rules and Regulations: y <br /> y \ <br /> JO$ ADDRESS/LOCAT ON <br /> ..., ::: .....:... ....... <br /> ....... <br /> .._ CENSUS TRACT <br /> Owner's Name .. � � ..............- ------------ <br /> ta�: <br /> Address ,��^^' - ,._.... ..---.._.........Phone .......... ..--•- <br /> ss 6• r`'..,..._.. '� City t <br /> ••-••-. ......._ <br /> Contractor's Name ...~ ,C i E - -- <br /> :/ � �4 ��" ................ ... �ioense. cr ���f.. Phone <br /> Installation will serve: Residence Apartment#lousefl Commercial EjTrctllef Court <br /> Matel.❑Other. ..,. ,.:.. _.,;......_ <br /> _ \ <br /> Number of livin � -_' <br /> g units• —__- Number of bedroom - <br /> •--- ge Grinder��=�__ Lot-.Size _f�� �`�.� <br /> Water Supply` Public System and name rba 4 � i ..... <br /> . .--•--._ -----........................... •..... - .Private <br /> ia <br /> Character of soilto a depth of 3 feet: SandEl. Silt❑ Cloy - <br /> ! ❑ Peat❑�„�$ate.team [�.. Clay am j - <br /> .. <br /> l , IHardpan p Adobe-0 -F€llMaterial� , � ...__.,..... if yes,+type...:::�` F <br /> (Plot� Iansize <br /> � �• <br /> pa , showing size:of�lot, €ocatlon of system In relation to wells, 'buildings, etc. must be placed ori reverse side. <br /> NE ) <br /> NEW-INSTALLATION: <br /> {No septic tank or seepage .pit permitted if publig sewer is available within 200 feet,} <br /> PACKAGE TREATMENT l ] SEPTIC TANK Sias <br /> _'... /�. - ? ..... ----- Liquid. Depth ................. <br /> ._.....- -- ' <br /> aci <br /> Ca ""- <br /> p t ra eV._..._ Type -- Moteriol4M,:� No. Compartments . <br /> ` <br /> Distance to nearest: Well ....._ „{...............:...:.Foundation . .fes..._ <br /> Pr .r.1 <br /> LEACHING LINE,. No. of Lnes p• �..._.._.... <br /> Prop. Line / <br /> * -- �- �I�--•• -•---- Length of -each line..?�`�----•--•• Total Length x �.............. <br /> �. _ .._ <br /> Boz� _ -,Type Filter Material/ Q _Deptk Filter Material� !..._.......:_.. Irl <br /> 5 •.. "�. .................. <br /> Distance to nearest: Well < <br /> -••...--.... Foundation ,/.r............• tine .94" <br /> Property _-_ 311 <br /> SEEPAGE t 1 ....__. <br /> Depth. l _ �, <br /> ..,Diameter"" .�. _ <br /> •-=--=-••----•-. Number .................-•-••__---- Rock Filled Yes � No <br /> Water Table Depth ..................../;._,- ..hock Size . . . <br /> ................. --••---••---•. <br /> Distance,to nearest: Well ............. ` Foundation <br /> ---•-••................. Prop. Line ' <br /> REPAIR/ADDITION{Prev. So" <br /> itaticn Permit :--••- Date <br /> ....... <br /> .................... <br /> ------ <br /> Septic Tank (Specify Re uirements):. ------••--•-. ............................................................. <br /> Disposal Field (Specify. Requirements) ............. <br /> -----------*------- <br /> - ••---------------------•--------- --------•......•-------- .......................•--............ <br /> i--------------------------------------------- ---••-'---------•------------•------------,-------•'------•- -.............-....................:.--•-•--•--•-•--....----•--••-....... f <br /> t `(Draw existing and required addition on reverse side)-,!-. <br /> hereby certify that I have prepared this application and that the workwill be done In accordance with San Jaoquin• <br /> County'Ordinances, State Laves, and Rules and Regulations of the San Joaquin Local Health.Disirlet. Home owner or licen. <br /> sed agents signature certifies the following: <br /> "I certify that in the performa'n'ce. of the work for which this permit is Issued, l shalt not employ any person in such manner <br /> as to become subject to WoEkmari's Compensation laws of California.,, <br /> Signed --- --------- I 4, <br /> = •------•-------------• ------•---- n <br /> BY ' � // `" <br /> . :.. Owner <br /> -------- _... Title <br /> li! � <br /> er than owner) <br /> ....................... <br /> -� FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _..-_�.,.,-A,:----,'------- -- - <br /> BUILDING PERMIT ISSUED - --------------------------------------------------------------•---------------•---------------- .--._......,.....,DATE <br /> ADDITIONAL COMMENTS -_.._ DATE ............ <br /> - --..._ <br /> -- ---- <br /> }r R ------- <br /> -__ <br /> _..._.- - <br /> Finat Ins &,L <br /> - •----.-___--I........................... --•--- <br /> EH - ......................... _..Date _. ..._:. ........13 2� 1-681, iv' '; SAN J3AQUIN LOCAL HEALTH DISTRICT <br /> 8/7lt 3M <br /> i <br />