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•-'f _-- � Ot.. f04- r !#i: 'r , .-- Eta• J �' <br /> FOR OFFICE:USEc� y �> . ���-� — �� .��-�-a. t .� 1� � '"°�� G�•°� � , <br /> C- dON FOR �ANITN PERMIT <br /> ------ - --- - ------------• --------- ----- r Permit No. . ---------•� ----- <br /> (Complete is Triplicate) i <br /> �U�'7 <br /> This Permit Expires 1 Year From Date Issued <br /> Date Issued -�- <br /> ----------- -------------------------------------- ------ g <br /> Ik Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is rl?c4 ompliance with County Ordinance No. 549 and existing Rules and Regulations: <br />- 1 _- J ---� <br /> CENSUS TRACT ---------------------- --JOB ADDRESS/LOCATION -------------- �. <br /> Owner's Name P�j L1 _ 1 -----1 _4416X �1f �--------------------------------=- ---------------- Phone � _°�__--©/ ' <br /> Address - -- <br /> 3.3--�---/-- - -------Xc----------------------------- City ----5�-- ------------------------------------•!•-•---- fi <br /> Contractor's Name --/h -T----- '. ------------% MCZ,! .License #lt�. <br />` Installation will serve: Residence Apartment House�❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number <br /> ------------- ---------------------------- <br /> Number of living units:-]--------- Number of bedrooms ----- ----Garbage Grinder/_/-d---- Lot Size _- - --------- <br />,y 1 <br /> { <br />� Water Supply: Public System and name ---------------------------------------------------- - ------------------------------------------------------Private ❑ .� <br /> Character of soil to a depth of 3 feet: Sarid'❑ Silt C] Clay ❑ feat❑ Sandy Loam •❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe-M Fill Material ----------- If yes,type -------------__---------_-- <br /> I' <br /> C (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.] � i <br /> I NEW INSTALLATION: (No septic tcfnk or seepage pit permitted if public sewer is available within 200 feet,) ' <br /> PACKAGE TREATMENT [] SEPTIC TANK [ J t Size------------------------------------------------ Liquid Depth -----------------.-------- <br /> Capacity ----------------- Type -------------------- Material---------------------- No. Compartments O II <br /> Distance to nearest: Well --------�-------------------------Foundation ---------------------- Prop. Line ---------____V ...... J <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-------------_-------------- Total, Length --------_-_--___-_ ........ <br /> I 'D' Box -.------------ Type Filter Material --------------------Depth Filter Material ------------------------------------ <br /> Distance to nearest: Well ------------------------ foundation --- ------------------ Property Line --------................ <br /> �. <br /> SEEPAGE PIT$ [ ] Depth Diameter _fi_----------. Number -------�!__ --------------- Rock Filled Yes [] No <br /> Water Tcible Depth ------------------ -----------------------------Rock Size --------------------------•----- <br /> r <br /> Distance to nearest; Well ----------------------------------------Foundation ----------_--------- Prop. Line _--------__-_°_- <br /> I -. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _------_------------------------------------ Date ------__--------------------------) <br /> Septic Tank (Specify Requirements) ------------ ----- ---- ----------------------------------------- ---------------__------------------- --------------------------- <br /> Disposal Field (Specify.Requirements) ---------- ----- ---- <br /> --------------------------------------------------=---------------------------- <br /> ------------------------- } <br />+ 1 ----------------------------------------------------------------------- <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 <br /> County Ordinance's, 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 performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subi t to Workman' Compensation laws of California." <br /> Signed - -------- ---------------------- -`---- Owner � <br /> .. Title <br /> ------------------------------------------ <br /> By �. <br /> ------- - - - --- -- - - ------- 1_.:---------- - <br /> {If o#her owner <br /> i FOR DEPARTMENT USE ONLY <br /> I <br /> APPLICATION ACCEPTED BY DATE ------'-1- $ <br /> BUILDING PERMIT ISSUED ----DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --------------------------:; ------------=--------------------------- <br /> -------------------- --------------------------------------------------------------------------------- -------------------------------------------------------- ------------------------- ------------- <br /> --------------------- ----- --- ----- ---[--------` ------ <br /> ------------------------------------------------------------------------------------------- <br /> --------------------- -------- ------ - ---�`�- ,�-J----------- _ - <br /> Final Inspection by: -- --- ------------------------------- <br /> --------1---------------------------------------------- - -------------------------Date -------------------------------------------- <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M G <br />