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FOR OFFICE USE: <br /> ADPL CATION FOR SANITATION PERMIT .4 <br /> P <br /> - ------------------------------------------------------- Permit No,. - <br /> (Complete in Triplicate) <br /> ---------------------------------------------- <br /> ----------- ,� ,� 3- <br /> �� � ,�. ���67 `= Date Issued -------�- 7d <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. <br /> 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 'C ------------ �------------- TRACT _S`3_l_--------- <br /> Owner's Name ----------s----- A.7 v iL'�_ta/�---- G_V-oj_ /.t -------------------------------------------------- - ---Phone'-, ------------------------ <br /> Address ------------- Qom'*5 ---- ------------------------------ City -_ '2,A gra r--------------=--------------------------- :------- <br /> Contractor's Name ---.------------- - ------- -----------=---------------- ------------------ --------License �V------------------------- Phone ----------------------• <br /> - - <br /> Installation will serve: Residence�'Apartment House❑ Commercial :❑Trailer Court ,❑ <br /> Motel ❑ Other ------- i I I <br /> Number of living units:_:-(_______ Number of bedrooms '3______Garba6e Grinder='_�______ Lot Size ---------- <br /> Water Supply: Public System and name ------------- -----------------•--------------------------- ----- -------------------------------------------Private Er__ <br /> Character of soil to a depth of 3 feet: Sand;' Silt.O Clay ❑ Peat❑ S Andy Loam -E] Clay,Loam:❑ <br /> t Hardpan ❑ Adobe E] Fill Material _________,__ 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 /> Wy 4. I (� <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 2.00 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ ] . Size-----------------------•---#-- ---------------- Liquid.Depth ----------------...--._---- ` <br /> Capacity -------------------- Type -------------------- Material---------- - ---- No, Compartments -----------•--- <br /> Distance to nearest: Well ------------------------------------Foundafiion ------------- Prop. Line ---------------------- <br /> LEACHING <br /> -------- --- --LEACHING LINE [ ] No. of Lines ----I_------------ ---- Length of each line-----------------._--------- Total Length ---------------------------- <br /> 'D' Box ------------- Type Filter Material :------- -------Depth Filter Material ----------'-------------------------------- <br /> w Distance to nearest: Well ------------------------ Foundation :---t------------------- Property Line ---.--------.---.---.--- <br /> I __ Number ---_ ------------------ Rock Filled Yes No <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter __-------____-- ----- ❑ C] <br /> WaterTable Depth -------------------------- ----=-----------------Rock Size -------�------------------------- ' <br /> Distance to nearest: Well _________ _______--_Foundation '_________________ Prop. Line----------------- <br /> ----- <br /> t, REPAIR./ADDITION(Prev. Sanitation Permit# ----- 17--- --------------- Date _������___________] <br /> r � :'��.s }4 *„+.tea. <br /> t gra. ....—.�.»—{ � <br /> Septic Tank (Specify Requirements} - ------- ----------------------------------- ----------------- i - <br /> v /-� J <br /> Disposal Field �(Specif L equirements) - Q` ` �-�� f� y--------160_n`r . <br /> ! i <br /> ------------------------ -------------- --- ------ ---------------------- -----------------�--------------------------------- ---------------------------------------------------- <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 done 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 perFormanc a work,*r which this permit is issued, I shall not employ any person in such manner <br /> as to becom su an! pe iAn laws of California." 3 <br /> Signed --- ----------------------------- Owner <br /> By ------------ -----=----- = <br /> z <br /> �,­ZFCR <br /> - -------•----= <br /> Title - <br /> (If other than owner) ' <br /> .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ` _.'DATE ..../ ------ -------- <br /> �d�oa ? <br /> BUILDING PERMIT-ISSUED ------- ==----------------- <br /> ------------DATE = <br /> ADDITIONAL COMMENTS --------------------------------- ---------------------------------=--------------------------- <br /> t,E .► i <br /> --- <br /> ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------=----------- <br /> ---------------- <br /> Final Inspection by y _ - Date � <br /> ---- -- ------------------- - ------ <br /> SAN <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />