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_ + 4 <br /> FOR OFFICE USE:, APPLICATION FOR_, SANITATION PERMIT <br /> -- -------------- -------------------- ----------- Permit No.. <br /> 7 o U <br /> -_ - (Complete in Triplicate) <br /> This Permit Expires 1 Year From Date Issued Date Issued ._._��._:_I <br /> Application is hereby made to the San Joaquin Local Health District for a.,;perm, i#jto construct and install the work herein <br /> described. This application is made in compliance with-C-oust-y-Ordinance-No-549-and-existing' Rules and Regulations. <br /> E <br /> JOB ADDRESS/LOCATION � Jam- ---- ------M—fiR -PQS/9-----------RD--_- ----CENSUS TRACT <br /> Owner's Name s <br /> ---;------ - ----6; .......BRACK E--T�----------------------------=---------------------Phone .-------------------- ------------- <br /> Address tr .... 3 --------r ------ . - - - -P -s ---- City ----------------------------------- <br /> Contractor's <br /> ------•------------------•-.--•---Contractor's Name-.� License # ----------------------- Phone --------------- -------------- <br /> Installation will serve: Residence RrXportment House❑ Commercial.;❑Trailer Court ',❑ <br /> - <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:___ l- <br /> -- -__ Number of bedrooms 3_.....GarbagE - <br /> e Grinder M---- Lot Size -/ Ag ----47---_�-- <br /> Water Supply: Public System and name - '3:--------------------------------------------------------------- Private ®�^� <br /> Character of soil to a depth of 3'feetT Sand' Silt i Cla r. Peat Sand 'Coam C1a-'Loam. <br /> p ❑ ❑ Y ❑ 1 . ❑ Y ❑� y �.. <br /> Hardpan I Adobe'❑ Fill Material If yes, type -----------------:= <br /> (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc. rrii st be pla ed, ort;reverse side.) <br /> NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is availabl ithin 200 feet <br /> 41 <br /> PACKAGE TREATMENT [ ] SEPTIC TANK T ] Size---------------------------------------------- - Liquid Depth -..--------{--------------- <br /> Capacity -------------------- Ype -------------------�. Material---------------------- NCompartments ------ .......... <br /> Distance to nearest: ell -------------------------- ___.-Foundation _._.___-_ �_,.__.-,prop, Line ..-._- ------ <br /> LEACHING LINE [ ] No. of Lines -------------- '___`.: gth. of each line----------------------------- total Length.,,_-------_- _-_---__---_-- <br /> D' Box ---------_ Type alter Material.............Depth Filter Mat ria) _ _._____..____.. <br /> Distance_to:nearest: _II r._..t-_. ---._-_.-�` Foundatmion ��`_� N, Poperty Line. ------------:_---___.__. <br /> SEEPAGE PIT [ ] Depth, --------------- ----------------- <br /> _-.-_ --_- __Ro k filled Yes ❑ No C] <br /> _ D ameter Number _ <br /> Wateh Table De th` -- yy--------------r�_---�--`--Rock Size -`------- ----------------- <br /> t - <br /> --- --------- <br /> Distance to nearest-.N -------------------Foundation �.-.---- ---------- Prop. Line ---_-_..__............ <br /> ------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -- _-,. ---..'-,-- _. ,- • ------------- Date+ ------------------------- <br /> r <br /> -_f--------------------) <br /> Septic Tank (Specify Requirements) ------,--�`- - ;%//� ------F..+OX------ ------Q-�-�L�_T_ Q_ ------ <br /> _r1_6 <br /> ----- --�J�_�� <br /> ed ,r _ C <br /> Disposal Field (Specify Relquirements) _r5�_ �_J------------;29( ___._W 1,) 1A �A_-_-1"t ___41IV k---_-__--. <br /> CAW71= -" -.D . " l: FSC l` l v E ----- E R_� -------P7 E --------- <br /> - .� <br /> `X r ,O ' ' ice. ---- ----------------------- <br /> --- <br /> - -------- �_ --------------- <br /> (Draw <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 Son Joaquin <br /> { <br /> County Ordinances, State Laws, and Rules and Regulations of the Sain Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the followin ' f <br /> "I certify t in the performance of the ork f r which this permit is;issued, I shall!not employ any person in such manner <br /> as to bec su ect to or man's Co a California.' <br /> Signed -- -- --` ----- -- - --- _ Owner <br /> -- - -- --- ------------------------ - <br /> . - 3 <br /> BY --------------------------------------------- _ Title ----- ----------------------------- -- <br /> ---- -----E <br /> (lf other than owner) t ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- --i_R_0----------------------------------1---------------------- ---------. DATE ------ <br /> BUILDING PERMIT ISSUED -------- ------- -•------------------'------- ---------- `----- ------DATE -------------------------- --------------- <br /> ADDITIONAL COMMENTS - i --°------------------------------------------------[--------------. <br /> ------ ------------------------ <br /> ___ f <br /> __ __-__ ______________________ .__.-___--__-________-___--___--------_-------- <br /> ---- ---------­­---------------------- ----------- <br /> -------------------------- ------------ <br /> - ------ <br /> Final In --- :�'.._i .3_�_y.-k° µ r.`�1_s i` Date ..... ------------------ <br /> ---- - ------ - - --.:- i ._.. <br /> -'� ��SAN JOAQUIN LOCAE. H�,4LTH DISTRICT •� �'��-' <br /> E. H. 9 1268 Rev. 5M. <br />