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FOR..OFFICE SE: : <br /> APPLICATION FOR SANITATION P <br /> ERMwIT <br /> .0 .---....... ..... .� . <br /> .-. .. _P_e..-r:vm_..€..t_N_ o-. 7 <br /> .�5 <br /> {Conp�le ii icate} : .....................a �75 <br /> . <br /> ..... . . ................................... Dane Issued <br /> ..................... <br /> ........................ ...._- Thi PermitEx i rr Frim Aa hIssted <br /> � <br /> - <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 Ord"inan"ce No. 549 and existing Rules and Regulations: <br /> ?s` ...........FJOB ADDRf55/LOCAT€ON � � / Q.W/ : ^v ... t <br /> Owner's Name !/P ..... � .. f _ ----•....................................................................Phone <br /> Address ...� 1 ...J /1 1P. s .......... ------------ •....-. --5......Ci#Y ----- . 7-0, T /V------ ------ <br /> Coniradar's Name Ac _.....S TTS-_-/201/x5....Sze__:.-...-.License #I/- -- Phone .y : <br /> 4 <br /> Installation will serve: Residence❑Apartment House] Commercial❑Trailer Court 0 <br /> Motel ❑OtherdC'__i� /�.._.._ <br /> Number of living units:- .... Number of bedrooms :-..Garbage Grinder / :_ Lot Size . o. ��................ <br /> Water Supply: Public System grid name .. .....---..- v _ <br /> ---------=------------------•-•--•._..._...._.........__.........,..._...._..---.._.._....._...._ Pri ate . � <br /> Character of soil to a depth of 3 feet: Sand❑ C-Silt E3%%Clay ❑�`LPeat,4 Sandy Loam ❑ Clay Loam ❑ k <br /> 4 <br /> Hardpcin1[j-w Adobe 0 Fill Material ............ If yes,type............... ............ (/3�'�} <br /> (Plot p +S <br /> n, show ng size. of lii#;""locdtion'cf`system'in,refatian'Yo`wells, buildings, etc.'must be placed on reverse' sidior <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer Is available within 200 feet,[ <br /> PACKAGE,TREATMENT �. <br /> r[: . SEPTIC TANK Size.-- � '. /• �• <br /> -��---. _.y...�..�'�.....------•- Liquid Depth --�`�....--•- -�. <br /> F r <br /> aCap ci TypeL'-�/�, �Ma#erial .l �'. �:r No: Compartments ... ._ <br /> -•-- ..._.._. <br /> 1 <br /> Distance # e st: Well . , ..._ ...Foundation ..fid r Prop. Line . <br /> ... . <br /> � No. of lines ---/--------• ! � <br /> LEAC E; �j <br /> ------. length of each lineF�f..,:t:.�-•------ Total Length ....1�__•-------------o <br /> 13vv 'D' Box Type Filter Material,.A:' 4'.i5...Depth Filter Material .1�...................... ..... <br /> �r <br /> ....... Property Line S <br /> Distance to nearest. Diameter + Foundation .1...___.._... ..._.. <br /> [ ! p ai.....� � .... Rock Filled Yes ❑Z. <br /> No <br /> SEEPAGE PIT Depth Number <br /> Water Table Depth -•-----,.---,....,.4 ._,......_ ..................Rock Size -------------------------------- <br /> Distance"to-nedrest: Welf..'._...___..:: � `"" "`Foundation .. Prop. Line <br /> REPAIR/ADDITION(Prey. Sanitation Permit Date ---------- - ..............} <br /> Septic Tank (Specify Requirements) ...................-•-------------•-------•-................................ <br /> - = - .................. - <br /> DisposalField (Specify Requirements) ...................•••. ..................--••...................................._............................................ <br /> ....................----.................... <br /> -----••-•-------- ------------------------ ----------- ...... --------•------------ <br /> _.....-........---------------------------------.. ------ ...... .............. <br /> (Draw existing dnd required addition on reverse side} <br /> I hereby certify that I have,prepared this application and that the work milli 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 of Men- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Wor man's Compensation laws of California." <br /> Signed ------------- ------ •------ - ---:------------ ................................ Owner <br /> BY ----- ---- • Title _.. X.1 <br /> --------------------- <br /> (if oth than own <br /> A I � <br /> EPARTMENT :USE ONLY <br /> APPLICATION ACCEPTED BY,.... .. -------•---------------- -----• ....................... DATE ..,.._f .,:.`�...__.�.�----: <br /> BUILDING PERMIT ISSUED ---- ._-.-....._DATE -----------•---•--•------------------------ <br /> ADDITONAL'COMMENT r ..........--•----------------------------------------------•---•-------------------------- ------- --•------........ <br /> . . .. <br /> -----'. . .... �u.�t. G( I u •�--•...............•--------...........-----•............................ .......------............----•----......_. <br /> •:--•-- --• •--------------- -- ---- ------.-...-----•---------. -.._.--•------..-. ....................-...r------ <br /> ---------------------....--•-----...----.-..._..... -� <br /> ------------------------------- --------•--•--..�. <br /> €inal Inspection by: ...............:..._ �... Date -..-. ..T25 <br /> -------------------•..---- •- -- <br /> EH 13 2L 1-68 aev, ! / SAM JOAQUIN LOCAs ALT DISTRICT 8/7h 3M <br />