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FOR OFFICE USE: APPLICATION FOR" SANITATION PERMIT 1 �' <br />......................................... ............. PermitiNo. .. -3....`.! . <br /> } (Complete in Triplicate) ,i <br /> ............................................. <br /> .. his Permit Explres 1 Year From bate Issued Date-issued ..`� �. •.-.�3 <br /> Application is hereby made to the San .Ioaquin`,Local Health,District for a permit to construct and install'�.the work herein <br /> described. This application is made in corripliartte ith County Ordinance No. 549 and existing Rules •anll-Regulations: <br /> JOB_AD_DRESS/LOCATI :._...:,...: - -�•t •L ../ / •• CE :. <br /> l NSUS TRACE <br /> Owner's Name N,.._. 7 ...� �.... -_-- ................. ................ ...........Phone ------ ...... <br /> Address ................ City _6�- ------....._.......................................... ...... <br /> , . 7f,J� '... Phone <br /> Contractor's Name . ._::✓.4�.....,. y .............. ..•.._.._.._ . --..._..._..._._.License . ..# ..l.G <br /> Installation will serve: Residence pattment House❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other :..... t <br /> of living units ......... Number of bedrooms .......Garbage Grinder_.... Lot Size ---- <br /> Number . ..- `-•• <br /> , R <br /> Water Supply: Public System and norne .....................................-----.........-----•--I .-------•-•-•ymr�•-- ------- -------- ---....Private� <br /> Character of soil to a depth of 3 feet: Sand.0 Silt❑ Clay C) Peat[] Sand LoaClay ❑ <br /> Loam ' <br /> Hardpan E] Adobe Fill Material ../ll . 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 sewer is available within 200 feet,): ' <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Sae_ ,X, -�-•_..........•..-.: -_ Liquid depth ...I.- .......~- <br /> 'T" <br /> Capacity _j-?_:�•-----.-- Type . .fes-. Material No. Compartments -•------._..::r. <br /> Distance to nearest. Well ! Foundation ::,....l. _�...... Prop. Line J.... <br /> LEACHING LINE No. of Linesf __ � .._.... <br /> . ---- Length of ch llne- � Total Len th <br /> .. f ) rr <br /> 'D'�Box . 1 :... Type Filter Material ..- �--.Depth Filter Material ._. ........................,.__.-.._-• <br /> . Foundation ... d.f.......... Property Litre . <br /> pistance o nearest:-Wel! ------ ......... '�•------•----•--- � r <br /> SEEPAGE PIT Depth Diameter . ... Number ....• -_ ......... Rock Filled Yes gg---Ro � <br /> .�. . »- . .._ Water Table Depths:_-:.::: _._:.: -::.::..........._.Rock Size.. ' `x ............. . <br /> .... .. <br /> rD.istonce-to. ZGls./,... Foundation ........ Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit+#....... ................... ....... .. Date } <br /> .............. <br /> } <br /> Septic Tank (Specify Requirements) . - ""--- <br /> DisposalField (Specify Requirements) --------- ............................................. ....•__.........._._..........�F.---------•----------__._..........---........ <br /> .................. .i------.................. <br /> .. -__. --_-. _ ------ ._._.__-_ _._............................ <br /> f <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 inj accordance with SantiJoaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local,Health District. Home owner or Been- <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 Workman's Compensation laws of California." <br /> Signed Owner 1 •/ <br /> ---------- -------------•---•-- ...... •-••--••----• 3.4 <br /> �,r. �9 �BY -... ._.. Title ....._.. :::.....: : : ...............I._.......... <br /> (if other than..Der) <br /> . <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION <br /> ACCEPTED BY `�( ------------------------ <br /> BUILDING <br /> .. •....... ••------.......:.......----------------f--. DATE ••--•---- ..... <br /> ...... <br /> BUIDINGPERM� ' <br /> ; <br /> - <br /> ISSUED ..............................................DATE.. <br /> ADDITIONALCOMMENTS ....................:......:...........•----...........-••---•-•------•--.................................._._.._,........---..............._.....---......... <br /> ._......•.......................................... -.....-- .................................. <br /> •- ......................_.........._ <br /> I <br /> .............. <br /> ....'..............._...--'.�..[........................................................... <br /> ............ <br /> .......................................................................... <br /> .......... '•• <br /> ..............I...................... .. '1 i"" .......................:......:.._......................._.__._................. <br /> ................... <br /> ,._..:_.._ _ <br /> Final Inspection by: .............•..Date ---._....._..... .--._..__........ <br /> _... , SAN .JOAQUIN �--------------._..,,--------------...... --- <br /> . . ,,, ... ... OCAL HEALTH DISTRICT <br /> c u 13 24 1--s.a oe.. KAA ` _ 7/72 3 M Ja <br />