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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No <br /> M c 41,n f Complete In Triplicate) <br /> `� <br />................................._...,..__..._.:..._--6:- Date Issued <br /> This Permit Expires t Year from 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 ........CENSUS TRACT <br /> yf Q...-1! ,..,NJ ±?..................•....... <br /> • � . Yf <br /> • .......Phone � 1~......_.. <br /> Owner's Namet .Sr@. ..L............................. <br /> ............... ......................... <br /> Address r►SfI ; �'Je II�� .............. . . .......... City ...s .................................. <br /> � <br /> r <br /> Contractor's Name license XfJ ..y -----.. Phone .`�.�.L.. <br /> Installation will serve: Residence"Aportment House Commercial[]Trailer Court 0 <br /> Motel ❑Other ................:.•••••••••---......_._.... <br /> Grinder Lot Size "`�' `�` &.'''•''w <br /> Number of living units:__-�___.... Number of bedrooms Garbage <br /> 1 <br /> Water Supply: Public System and name .._ ....................................._••- ..............................................Private <br /> Character of soil to a depth of 3 feel: Sand 12r' Slit Z3,1Clay Peat E] Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Material If yes,type ............... ............ <br /> (Plot plan, showing size of tot, location of system .in relation`,to wells, buildings, etc: must be plated on reverse side.) <br /> NEW INSTALLATION- {No septic tank or se permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT J.] S ' <br /> Size.................... ........ Liquid Depth <br /> ..._................_....� <br /> .ATICTANK T ] <br /> Material............... No. Compartments -_..-......_..........0 <br /> . - Capacity ....... ---_:.: Type <br /> Distance to nearest • Wel#` ......Foundation .....___i.�y,_---Y Prop. Line . .................... <br /> .-.. - R .� <br /> _. Total.' Length' <br /> "�:'• nes � - � length of each tine.......................... ......._.... .---......_... <br /> i LEACHING LINE ] D' Sox •:f Depth -Filter Material .....-_...•••- <br /> ' �•-•------- Type: Filter Material ....-------• ................ <br /> `�' Foundation Property Line <br /> 'Distance to nearest: Well ---------'----- - __..-....-•............. <br /> SEEPAGE PIT [ ) 17ep1h ._.!-•------------- Diameter ._.._.....--_-__ Number _........................... Rock Filled Yes ❑ No ❑ <br /> L{Fr <br /> I' <br /> Water 'fable Depth . .......................Rock Size ............................. <br /> __-•__..Foundation Prop. Line ••• / <br /> -Distance to nearest: Well ....................•-•----• <br /> REPAIR/ADDITION(Prev. Sanitation Permit ......................... <br /> _ Date ................ } '1 <br /> i .•--...----••-•--...... ----..........................•_.. <br /> Septic Tank (Specify Requirements) ................................ -•--••.•--_._.... •_ N <br /> • i <br /> . <br /> Disposal ,Field (Specify Requirements) J� r <br /> -- Otc-]r7e.& <br /> -------------- ----••--....----•---- --------------•-•----•- -----__....._...-........_._..........- <br /> (Draw existing and required addition on reverse side <br /> I hereby certify that l have,prepared this application and that the work will be done In accordance. with Satz 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 /> 111 certify that in the performance sof the work for which this permit is issued, 1 shall not employ any person in such manner <br /> i as to become subject to Workman's Compensation laws of California." <br /> t Owner <br /> Signed ------------•;------------•-----'"------•------- -- ..................... <br /> r� . ............ <br /> ... Title - . s /�_... <br /> B f ,- <br /> f (If other than owner) <br /> FOR DI:PARTM NT U ONLY <br /> ......... <br /> APPLICATION ACCEPTED BY --- --------------- ------------------- -- <br /> DATE ....: <br /> BUILDING PERMIT-ISSUED'.-- --- '----- --------------•--•-------- -­­ ----••---... ....... --•- <br /> DAT <br /> ADDITIONALCOMMENTS ----• ----i--- ------------ ---•----•-- -•-----._._....-•-•-••-..._-__..... --•------- ---------- •----- - <br /> ----- . --- -•---------------------•-----• -----------.. ...-.1............----. .--._._.._, ----.. <br /> -- ... . <br /> I ---------------------------- ------- -L•....----- .-•----...-- •------------ - -- .......- --------------I........... <br /> -----------------------•------------.-•------.._..._ Date _-..-.Zl-'Za- .�--. -----......._.. <br /> I Final Inspection bY: ----------_:........................_..--•---••-- --•-•--•...•----•--•--...._.--•--13 A -..._ ._ . <br /> ' EH 13 .24 1-6ev. 5M a SAN JOAQUIN LOCAL HEAL DISTRICT 8/74 3M <br /> I <br />