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-FOR OFFICE USE: IT <br /> APPLICATION FOR SANITATION PERMIT /"� 4� � <br /> Q: o Per . .... <br /> : �. .... .....:...... r... <br /> Permit No 7�•~ �� <br />{ (Complete In Triplicate) <br /> ato issued .. <br /> 7 <br /> , <br /> .. /.• This Permit Expires t Year From OaN issued. <br /> ............................. <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and Instal( the work herein ; <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations.i <br /> JOB ADDRESS/LOCATIC?N �D R�.!?L.... T'.... <br /> _CENSUS TRACT ....... : ..... <br /> + <br /> Owner's Name � 'Z .Q �.. i ftt4 ..- ---•...............................Phone ..9 <br /> �- 9 3� <br /> _... .� City aQ<�.r_.b xl..................................... <br /> _.. . 639 <br /> Address -------------------­k -----`j�! � .._.. Ci .... .............. <br /> Contractor's Name -.. <br /> License # <br /> Installation will serve: Residence Apartment Houses] Commercial oTroller Court 0 <br /> Motel ❑Other............... -------�......... <br /> _... /.SO x 5�J a <br /> 1 4 <br /> Number of living units:----- Number of bedrooms -_•.....:-_Garbage Grinder :........... Size . <br /> Lot ..... <br /> Private ' <br /> Water Supply: Public System and name ...... <br /> Choracter'of soil to a depth of 3 feet: Sand 0 Slit El Clay ❑ <br /> Peat Sandy Loam.❑ Clay loam� y O <br /> ' Hardpan Q Adobe Fill Material ............If yes,type ............... .•...:..-... UU <br /> r <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 feet,) <br /> Li uid Depth <br /> .. cx�...... <br /> PACKAGE TREATMENT [ ] SEPTIC TANK• Size..- ... p <br /> Capacity 1_�.Q� Yip t`........ _ • Material <br /> No. Compartments ...1-_...... . q <br /> . . 0 Pr Line .. . .. .......... <br /> Distance.to nearest: Weil ��...... ...Foundation __.. ............. op. <br /> .. <br /> 11 <br /> No. of Lines _._ ............. Length If.each qne s ----......._ Total Length . <br /> --•........... <br /> LEACHING LINE 14 �`� <br /> r� <br /> D' Box Type Filter Material .. t� .._.• .Depth .Filter Material ..: ..tl.:...:............: ¢ <br /> d Property Line . _........ <br /> Distance to nearest: Well Found tion ...---- --.- <br /> r� No.Q9 . <br /> SEEPAGE PIT Depth -� .._. Diametter :----• Number ....... ..........:......... Rocky Filled 'Yes Y s <br /> .ILock Size . <br /> Water Table Depth -!�` s J•- '/ rc <br /> r <br /> . Distance to nearest: Weil �:�:.�_.......----k <br /> .....Foundation .---/-2.... .--- Prop..Line <br /> ine . <br /> REPAIR/ADDITION(Prev.-Sanitation Permit# ..::___. Date ---- _ -••-...•---• ) <br /> . �� - ._... _ -- _... = �...... ----..........--------------••-----••. '... <br /> Septic Tank (Specify Requirements f..................•----- ---• <br /> . <br /> Disposal Field (Specify Requirements) -------•---- ........ <br /> -----------••----. ----••-- -- --- <br /> 7. <br /> ----.-.-----•--•-- <br /> ---^•-----------------------^----_..----------_._------._-......___........__-_-_-......--_._......._.__.....--•-•-•--..._.. - <br /> � Led <br /> Draw existing and required addition on reverse.side)1 hereby certify that I have prepthis 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. Horne owner or liven <br /> sed agents signature certifies the following: erson in such manner <br /> I "I testify that In the performance of the work fair, <br /> or which this permit is issued, I shall not employ any p <br /> as to become sub(eck4- Workman's Co pensatio laws of Caiifornin. <br /> Signed __Z.0---- •--- .. ... .......:..... -.... <br /> •:---� ..--Owner <br /> --------- ----- ----- ---- Title <br /> :_ --- <br /> (if other than owner) I <br /> I DEPARTMENT USE ONLY. <br /> DATE <br /> APPLICATION ACCEPTED BY. .cam. __._......, .-_.=_ .,. <br /> =- <br /> .�. ---•*..•------------------ DATE -�-- .:.-•---._.__-=---- ----- -- <br /> BUILDINGPERMIT'-ISSUED .. _ _.. . --------• .......................... --------_...-.__.._....• <br /> ADDITIONAL COMMENTS --- ---- - <br /> Y -- -------------------- .......••. . <br /> ...--.-----. <br /> ,.,. ,.. . <br /> ----- ---- ----- - --------- --_.--_ ----._... -..._ .... Date .... ... '� <br /> Final inspection bY= -•--��-- - --- - - - - - -----••------••---.,... - - <br /> EH 13 211 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT /A 3� <br />