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FOR OFFICE USE. ~` <br /> APPLICATION FOR SANITATION PERMIT �T <br /> (Complete in Triplicate) Permit No. -.7...... ......... <br /> This Permit Expires 1 Year Froin Date Issued Date Issued ../-. .7 <br /> Application is hereby made to the San Joaquin Local Health District J& 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 /> //�� t <br /> JOB ADDRESS/LOCATION <br /> �... �.. ..YJ::.. . .... . -- - GGc�... CENSUS TRgACT .......................... <br /> Owner's Name .............. �� ',•x.,t ... ....... ----------_- ............ Phone .`, fl. <br /> Address .........:........�-5 ... ..... City <br /> ................ <br /> Contractor's Name - ..... ... .. .... .. �....� _ -------.License # i+-_3.. 3__. Phone . .�.-f��0.7... <br /> Installation will serve: Residence Apartment House-E] Commercial ❑Trailer Court 0- <br /> Motel ❑Other ..----- •-•---------------- <br /> o 1/ <br /> Number of living units /... Number of bedrooms .lot Size ...--_1.e•-__�����1-��........ <br /> :... <br /> Water Supply: Public System and name _.-.. •.---------- -------------- 1 i -- <br /> Private <br /> - ....R......- <br /> Character of soil to a depth of 3 feet: Sand n Sift❑ Clay ❑ Peat❑ Sandy Loa [] Clay Loam ❑' <br /> Hdrdpan ❑"`""Adob'e�[� Fil! Materiafi [_ „�_. If yes, type....._-------------- --- • <br /> {Plot plan, showing size of lot, location of system in telation to wells, buildings, etc. must be placed on reverse side.) <br /> I <br /> NEW INSTALLATION: {Na septic tank or seepage pit permittd if pvbfic.sewer�is,avaiiabfe within 2d0 feet,�. y <br /> PACKAGE TREATMENT [ } SEPTIC TANK t ] Size .--_-._ �-..-.. -. _-..� Liquid Depth ..._..................... s <br /> Capacity .. . .... . ..... Type ..----- Material...-.....-.-. - _.-. No' Compartments I y-� <br /> Dista ce to nearest: Well _ _.........._-------------------Foundation ..... ... Prop. Line .................... <br /> �1 <br /> LEACHlN LIN '[;lNo. of Lines tha I I f each line .....-_. .... ....}Total Length ..................... <br /> ......:6 <br /> L�` ge <br /> rt <br /> J. `" 'D Box ...-- . . . Type Filter Material t------------------Depth Filter Material -._ - 1...=:... ...F._ --.. -_---- <br /> Distance to nearest: Well ----- .-_--_---- Foundation ..----- - -- -------A_ Property Lie�1j._,.............__ - <br /> SEEPAGE PIT [ ] Depth .. ... ..... -- Diameter -•-------------- Number ...- Rock Filled Yes 0 No <br /> ...�� Water Table_Depth--------- ------------------------ Rock Size;.-..-._ ._.... t <br /> s <br /> Distance to neorest:.Well;'..:..'--. Foundation . t .. Prop. Line ................ <br /> REPAIR//4DDIT ONI{Prev. Sanitation Permit# ............. Date ----------.-.---.--_--�----.._....} <br /> Se ficaT ltiiSp#cify Requirementsl t w is - ----------------=•----------------------- ------=----.-------- --------- ------- <br /> Disposal <br /> .- <br /> Dis osal Fieldt5 ecif. wRe u.irements)..y:,ttt- - -�—. _...'....i !- <br /> P I r t -�-sf.� <br /> p Y q y .: ... /.r B-. �C�rcU-rit�l ... 3 <br /> . - 1 33....x.- i. . . .... . <br /> .. ;.... ' <br /> \V. g k A q i' <br /> (Draw existi►i -and required addition on reverse'sidel�.,� i <br /> I hereby certify4that 'I have prepared this application ci d'•that the work wiii`be done,in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Loccil ,Health District. Home owner or licen- <br /> sed agents signature certifies-the-follow' - .--- � "� - . _ `' i <br /> I <br /> "I certify that in the performance of the work for,wh�ich this permit is issued, I shall not„employ any person in such manner i <br /> as to become subject to Workman's Compensation IawsTof California."_ =_— <br /> Signed -:..�..... ........ . ..... r.... ..---.. - ----...--- Owner <br /> B r•--- <br /> y .... �..__........ -- �........... Title,. �. <br /> �.. ... . <br /> {I of `than ov'vnery <br /> OR_D6PARTMENT_LISE_-0NLY^. <br /> APPLICATION ACCEPTED BY .- _. .__. �� - DATE J? ---- <br /> BUILDING PERMIT ISSUED ......._./............... .... ;._.Y DATE ..... ...-......... <br /> ADDITIONAL COMMENTS ...................._....-----....._ -. •..:I._`_. /1.... <br /> --------------------- .............-.. ,...._ _.._ ...._..... <br /> --- _ <br /> ... <br /> ..................... -- -- - -- - <br /> - <br /> �� <br /> •• .......... Date <br /> Final Inspection b <br /> SAN JOAQ IN LOCAL HEALTH DISTRICT <br /> C 41 � � 7' • .sem �. - �,• --.. - ... � � � 1.. w - • <br />