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! -FOR-°-OFFICE USE: W <br /> APPLICATION FOR SANITATION PERMIT <br /> _____________----------_- (Com tete in Triplicate) Permit No: _ --- -(�r�-_ <br /> A t <br /> -------------------------- ----------------"------- This Permit Expires T Year Frons Date Issued Date Issued:"_ 7 S-_�3 <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 />� l�c� /f9 /rrrL� <br /> JOB ADDRESS/LOCATION ..__-. Lb --------C j ------ ENSUS TRACT <br /> Owner's Name -.110C.416 Q G lM .�J/Y1 1164'c A--f- C1 / ✓L <br /> -Y------------Phone . <br /> Address 1?- d�G�rf`J LI. ---------------- _ City r <br /> f Contractor's Name __ 444-- 2,-ell'�------------------------------------------------License❑#�'S`.�J�a� Phone ���LL�� •� <br /> Installation will serve: Residence N Apartment House❑ Commercial : Trailer'Court ❑ <br /> Motel 0 Other = € <br /> Number of living units:___- ------ Number of bedrooms _3___.Garbage <br /> Water Supply: Public System and name ------------------------------------ <br /> -------------- ---------- --------- --------- •---•- _ Er- -------------------------------- - <br /> Private <br /> Character of soil to a depth of 3 feet: Sand'(] Silt p Clay ❑ Peat❑ Sandy Loam A Clay loam.❑ <br /> Hardpan ❑ Adobe ❑ 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; <br /> -i { -_-, -_ tank or_seepage,p.it_permitted_if,.public.sewer,is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' ''� <br /> [ Size: `--- Liquid Depth ---------------------•- <br /> Capacity -------------------- Type ------------- -'_ Material--------- ----- ----- No. Compartments <br /> ------------- <br /> i Distance to nearest. Well ------------------------------------Foundation -------#-------- -"_-- Prop. Line -----------••---_--_-- <br /> LEACHING LINE [ ]i No, of Lines ---______ Length of each line________________ <br /> """ -"" -� "-. --�_ Total Length <br /> __ Type Filter Material --------------------Depth Filter Material <br /> ) Distance to nearest: Well ------------------------0 ' `�"n`'""'""``'"'`"�°` ""�"�_"r-- •:f�-;-..Foundation --- <br /> --------------------- Property Line ------- <br /> SEEPAGE PIT Depth _ Diameter _ Number ------ -------------- -`--- Dock Filled Yes ❑ No i[ <br /> �. Water Table Depth ------------------------------------------------Rock Size ----------- <br /> q Distance to nearest: Well ------------------------------------ Foundation <br /> - - ----- -=------------ Prop. Line --------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _.----------- <br /> ._____. <br /> --------- ---------- ------- Date ------------ ' <br /> Septic Tank (Specify Requirements) ________________--, __- t i <br /> s ----------------------------------- = <br /> Disposal Field {Speci'iy=,Requdcements) ----- ,�', I f <br /> ----------------------- . - =------------------------------------- ----------------'-- ------------- ------------------------------------- <br /> (Dr-aw existing and required addition on reverse side) i <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, ; nd Rules and Regulations of the San Joaquin TLocal Health District. Home owner or licen- <br /> sed agents signature certifies the Following: 1 <br /> "I certify that,in-rthe perFormance�of the work for which this permit is issued I shall-riot en to any - -' <br /> as fa.become suli ect�,6_ ork ri's Co nsation laws of Califotnia." `�4 ti '' rp y y person in such manner <br /> �z`. .. Owne <br /> _r c i <br /> Y ------------------------------ ---- <br /> r <br /> I - ,:;--�=-�----- ---------- -- Title <br /> } <br /> (!f other than owner) - .}-,, -- ---- - - --------- ------------ ---------- <br /> _, FOR DEPARTMENT USE�,ONLV <br /> APPLICATION ACCEPTED 6y�..------ - _caw,, s <br /> BUILDING PERMIT ISSUED _..i --------=-- ----- —22 4 <br /> i : t. . : DATE �C-�� ---•------------------- <br /> 1----- <br /> ------------ <br /> ADDITIONAL DATE <br /> COMMENTS p ` 3 ----- ----------- <br /> --------- <br /> ------------------------------------L • --- ----- --- ------------------- <br /> .- <br /> ----- ------- _ __ ---- <br /> Final Inspection b -------- ------------------------------ -------- ------------ <br /> y: D <br /> --- - ----- -- -- --•----- ��-`'--- - ------�"-�----------- -'----�-------- ��-:."----------------------. ate -----,��--` _'"-�-3__. <br /> -SAN JOAQUIN­LOCAL-HEALTH DISTRICT— <br /> E. H. 9 1-'68 Rev. 5M <br />