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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATIOI *OR SANITATION PERMIT p a <br /> r, <br /> (Complete in Triplicate]•` �;, .� !� Permit No2e:71d�—,-� <br /> Date IssueclJ2,-4r._73_ a <br /> ••-••••••---•••••-•-------------------------------- This Permit Expires I 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 described. <br /> This--applicatiomis-made-in-compIiance`with-County-Ordinonce-No-549-and-existing-Rules-and-Reg ulation s: <br /> JOB ADDRESS/LOCATION.:: ��d•1--•— Iv`�1g/iC0`J. ...... ..__------=----------CENSUS TRACTr_.......----- :...---....... <br /> Owner's Name...._ �f,.........flX.� .............. ..... ........................................ Phonep.L�''" L <br /> Address--------- ................... -------------------- ----------- City----`VZ7 ...........Zip---- 1---•-. ----- <br /> % <br /> Contractor's Name----Iye�:5......� .-. -lj//C...��/��.- .- License #/-�:/-.1?Y� 7 -Phone. ` Lam/5d 74 <br /> i <br /> Installation will serve: Residence 0( Apartment House E] Commercial C] Trailer_- Court ❑ <br /> Motel 0 Other---------------- - > <br /> Number of living units:..J.............Number of bedrooms...--...Garbage Grindar,V P.--Lot Size./.2�./4.�'/C6 ------------------ ._..... <br /> } <br /> Water Supply: Public System and name. .---- ----=--------- Private <br /> #..... - ! <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sady1oam [❑ Clay Loam El <br /> Hardpan E] Adobe Fill Material -.-.If yes, type_I z_............................. <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,'.etc. must be placed on reverse side.) i <br /> NEW INSTALLATION: (No -septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' <br /> PACKAGE TREATMENT l� <br /> ( 1 SEPTIC TANK Size..f 3`. -------------- ...---- Liquid Depth...1'V--- ---------- I <br /> Capacity00: ff _.Type � $ -.MateriaLZ '�No. Compartments-___, ___. <br /> _----------- --- <br /> Distance to newest; We11.__. ` __Foundation__._ 0:. .............Pro Line.. ` <br /> ------- --- P• � <br /> LEACHING LINE DO No. of Lines..-...................... Length of each lina... Total Length ........................ <br /> D' Box _ Type Filter Material.. G� '---.Depth Filter Material:._��.. <br /> . . -.----•.................... ............. <br /> .................. w <br /> Distance to nearest: Well--V...-..........._Foundation---la..................Property Line... .....-....--............... <br /> SEEPAGE PIT ' De th.-A tDiameter-. ,W let <br /> Number <br /> Water Table De th.. ._f�------------------------------ <br /> �...-----Rock Size.-'--1�a 'X '-Rock Filled Yes�J No <br /> ♦• .�' <br /> P <br /> Distance to nearest; Well -_RIO................... .....Foundation---l.O- -.. . _.._...Pro Line__.-� t <br /> I ) �> <br /> REPAIR/AbDITION (Prev. Sanitation Permit#---------------------------------------------------Date.-------:----.--.------.----------.-----................................ I <br /> Septic Tank (Specify Requirementsl--------- ---------- --- .._.....-_.. --------------------------- <br /> Disposal Field (specify Requirements)-. ':..........:....... --------------- • ----------------------------------------------- <br /> ----------------------------------- -•---------------- ----- --------.... ----------------.------- - - - <br /> •--•----•- -•---------•- ----•--._....---- - ----..---•----- --------...-------- - <br /> -•--•--------- .----- --------------------------.......i -- <br /> .- ---- -- ------- .......-----• <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 County <br /> Ordinances, State Laws, and Rules and Regulations'of the San Joaquin Local Health District, Home owner or licensed agents <br /> signature certifies the following: I <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 as <br /> to become subject to Workman's Compensation laws of California." <br /> Signed-------------- Owner <br /> c <br /> BY ..............Title <br /> ------ --- ----------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY d <br /> APPLICATION ACCEPTED BY.................r, ...................................... <br /> -------- - ---- -DATE ---1v�.-1. .. 7ct........ <br /> .. DATE ....... ...:............... <br /> DIVISION OF LAND NUMBER-/........ ...... ------ -- <br /> ADDITIONAL COMMENTS.A ` -- ----.... .Q?r. =-. ------------- -_ <br /> --------------------- <br /> psLfs .... .. " '�S`� <br /> ------------ --------------- -------- . ..... -------------------------- -------------------- --------------------------------- --------....--------------------- ............... <br /> tiFinal Inspection 6 .... <br /> ! ---- --------- ------------•-------------------------•---••--------.. .. ------ -- -------...Date....../02.:. . ...� ._..........# <br /> " 's 24 _ SAN JOAQUIN--LOCAL-HEALTH-DISTRICT Fos pian aev. ���a 3M <br />