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FOR OFFICE USE: =.� � <br /> APPLICATION FOR SANITATION PERMIT <br /> --- �•----•-----•.......... . ............. Permit No. .7.7�.Ic..y.. <br /> (Complete in Triplicate) <br /> .. This Permit Expires I Year From Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Health District_ for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB .ADDRESS/LOCATION ...M:56 _14/...-�/°TI���LiJ�...� _.._. ../�!��I�US TRACT ......... ...... <br /> .-y^ .............. <br /> Owner's Name _.cl.�_1 L�i� !. HCl /./1� ,........ .......Pho <br /> Address ------��.- ---�.�`�/��'C�-�'._.._.._ ... k._..----._... City ;.�. �. _ ... ........................... . <br /> Contractor's Name ................license # f7- Phone <br /> Installation will serve: Residence Q Apartment House f] Commercial QTraller Court 0 <br /> Motel ❑Other ._• sr .r..-._... <br /> Number of living units------------- Number of bedrooms .._..._::Garbage Grinder ............ Lot Size ... .................. <br /> r <br /> Water Supply:;Public System and name ---- ----------------••-------- '="` ..............................................,................Private <br /> 'Character of soil to a depth of 3 feet: Sand Silt:0 d Clay_Q} Peat E] Sandy Loam p Clay Loam El <br /> Hardpan ❑ Adobe Ip Fill Material ............ 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,[ f <br /> PACKAGE TREATMENT [ SEPTIC TANK �-- Liquid-Depth ....... ....---•........ <br /> Capacity Type Mdterial_Lsat_.----_---- No. Compartments .or........ <br /> � <br /> Distance. to nearest: WellD_�?.....................•Foundation ---lf,?.._....•----- Prop. Line ...._-•,?�.............. <br /> LEACHING LINE ] No. of lines ..___. r Total Length .:... G <br /> � 1-----•---..._. Length of each line..-.-7- 0:........... .. g ......--••---- <br /> F 'D' Box _-- Type Filter Materia! LkA ..r...Depth =filter Material ..-•/�--�', <br /> .......................... <br /> Distance to nearest: Well .. - -.f_.� -Q <br /> _... Foundation _.. ..PProperty Line <br /> p ,,�..__._.... Pro a .. ............... <br /> SEEPAGE PIT { ) Depth ----------------_- Diameter ................ Number _._......... ............... Rock Felled Yes ❑ No O <br /> Water Table Depth ...........................Rock Size ................................ l <br /> Distance to nearest: Well --.-Foundation .... Prop. !Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit* ............................... . Date ...:....__-_------------------- -1 t � <br /> Septic Tank (Specify Requirements) -------_--------- ................ ------ ---------- -------_-----_-- •-•----------------•----------- •--.-....... <br /> Disposal Field (Specify Requirements) --------_------_........ ................................................................................._.........--•........... <br /> ---------------- -------•---• ----------------------- ------------------------------------------------------- •----•.............................--------------..__....._.....s....._...-----•--...-----•. <br /> { <br /> i ------------------------------ ---------------------------•-------------............................................................................................ <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 Ordinances, 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 hero svbiect to Workman' Compensation laws of California." <br /> Signed ".._ Owner <br /> { <br /> .... ........ .................... <br /> t � w # <br /> BY - Title _... u <br /> (lf they an owner) <br /> t <br /> I _ FO PARTM T-IJSE_ ONLY :... <br /> �._ <br /> APPLICATION ACCEPTED B ' DATE ......//-, f. ?2 ----- <br /> BUILDING' PERMIT`ISSUED ---�•-�-/-- ----- ----------- <br /> A ATE ........... <br /> ADDITION L COMMENT _.I.!�. !?Y!I C_.cctr�: ,:.. --- -- . �'zs' `�' <br /> _...... •--•. ............. <br /> ' ---------- ----- <br /> QQ --.....- <br /> FinalInspection by: -•--------Lei„----------------------------------------- .. ................... ..._..._............----•....__Date � - •----------- <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/_7h 3M. <br /> 'r <br />