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-,,FOR-OFFICE USE: <br /> APPLICATION EOR SANITATION PERMIT <br />:. .' y....----.... ........................ I Permit No. <br /> I (Complete in Triplicate) <br /> >.................................... .^ <br /> Date Issued _r..5Lzl <br /> ...... ....................... •..,,, This Permit Expires 1 Year From 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 Ordinance No, 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .............. ,-?........ .................CENSUS TRACT ......... <br /> Owner's Name .............. �!' .�.... S�aa�....-•------- _............... ............Phone ......,-tl......----•---..........-- <br /> Address ._............................. <br /> . •-••--•-••---- city .c ...... <br /> Contractor's Name ...... :.t�:_.. ..fF►°-Qss _. $-rLicense # -�� .. Phone <br /> Installation will serve: Residence PkApartment Housef:] Commercial f3Trailer Court 0 k <br /> Motel ❑Other ----------- -------------------M............ <br /> Number of living units:---- Number of bedrooms 1.._.Garbage Grinder .._.... ---- Lot Size ....: ............. .... <br /> Water Supply: Public System ondiname ------------------- -_-------„_-_--..� .......,-.. Private (� <br /> Character of soil to a depth of 3 feet: Sand o Silt`p Clay O ” Peat❑ Sandy Loam {] Clay Loam ❑ <br /> Hardpan ❑ AdobeFinlateri'al ............ 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/slewer is available with in_200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[ ] . Size ..................................... Liquid Depth .................... ----- <br />;� .- Capacity .... .... TF pe _.�"...�.'....'�`._.�. Material...................... No. Compartments ...................... � <br /> ` Distance to nearest: Well Foundati in .--_.. Prop. Line <br /> ... <br /> .... _... <br />_3 <br /> r j of.' each line._.. Total Length <br />- LEACHING LINE No, of lines ......-._.�_,._... ._ -Len th <br /> Depth Filter Material -_____._-__--_.. <br /> D' Box ............ Type Filter Material .. .... p <br /> C <br /> Distance to nearest well ......... ..... /-.. oundation .....- ---- _....... Property Line ........................ e <br /> SEEPAGE PIT [ ) Depth ._.................. Diameter ................�.Numdr ....�..--�------ <br /> ....... Rock Filled Yes ❑ � No i <br /> Water Table Depth .1. _.._.------ •---••••::_...•------..Rock ixe .. it ; <br /> ....._ <br /> -_ - Foundation <br /> Distance to,nearest:.Well ----------------------••-----._ ._...... -----.....,:-----•-- _.. <br /> REPAIR/ADDITION(Prev. Sari ta`tion-Permit# ....---•._..--.--• ......... Date Date ....----......_......--•--_-••-•--) ` <br /> Septic Tank (Specify_ 'Requirements), ---=---,•- = -,---�--.._�.�Lar�...c ir: ...:..._._. � ..---•... ......................_...._--------------------- <br /> Disposal <br /> ............---------- <br /> . .. ---•-Dis osal Field {SpecifY Requirements) v5k .........Q . ...................... - <br /> gg <br /> ...-•---•...--------•--------•--• ................. --••-- <br /> ...........................................................,.................................. <br /> ...... ......................... ............................I.--__.."..,....`......--'--�--•--------------.......------.........---------....... ---------------••--• . <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ord inances,_5tate,Laws,-and Rules,and•Regulations,of the 5an_Joaquin Local Health District. }Lome 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 War an's Compensation laws of California." <br /> Signed — ••-.......__. <br /> Owner <br /> . <br /> - Ti I <br /> ................................... <br /> By _X <br /> If other _.....•.... . ............................... <br /> owner) t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. _ .': .. 22 _ ...,........ DATE ...,3.:n9k:•=f7.X.......---- .. <br /> BUILDING PERMIT ISSUED . ..... <br /> DATE ............. <br /> ADDITIONAL COMMENTS t . .....- ... ....._._- ..1.,. .......................... <br /> ............................ .�.....�.I ... ...................................... . ..... <br /> ....................I....................­............a......................... s .. <br /> t ....................................•--------....-.---....._..._._ ...... <br /> Final Inspection by: ---••• ` y Date _.. ...� .-7. ... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c u 13 241_•s,Q Dau +SAA 7/72 3­14 <br />