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FOR OFFICE USE: <br /> t s. lO p APPLICATI6N FOR SANITATION PERMIT <br /> ...................... r . Permit No. _ .:........... <br /> .'` (Complete in Triplicate) <br /> ..................................................: <br /> ` t Date Issued f�... . <br /> ............ ............. This Permit Expires I 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 it compliance with County Ordinance No. 549 and existing,Rules and Regulations: <br /> JOB ADDRESS/LOCATION .t(. +fQ .._ .!__ _ .......... <br /> .. .�/•-..._CENSUS TRACT ..:---...._... <br /> Owner's Nome .ftrufjo.!!lf�..rr:..��.QL�S �_��1�............................... :••-----.............Phone .�.�j. & �1......--- <br /> Address ............................ ?d_......................... ----•--- ................___. City ......................................,..._._............................... <br /> Contractor's Name *.4�.A.4; 9t------...License # .---•................... Phone <br /> f � <br /> Installation will serve: Residence XApartment House❑ Commercial []Trailer Court 0 <br /> 'Motel ❑Other .......... --' <br /> 4 - i <br /> Number of living units:----I...... Number of bedrooms?--.-.--_Garbage Grinder ....._..___. Lot Size .�e��--_�-...1�Q.._._.. 4 <br /> Water Supply: Public System and name .-.__ ----------------------------------------------------............................................:.......Private <br /> Character of soil to a depth of 3 feet:k Sand ❑ )Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loom` <br /> Hardpan ❑ Adobe ❑ Fill Material ........__._ If yes,type --------_------_-_- <br /> t <br /> .------.._____....... <br /> (Piot 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 tdrik or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTICiTANK-T ] Size--.-•_____________________ ................... Liquide Depth -:------..._.........:_-.. <br /> � 1 t <br /> Capacity ..... Type --- Material....................... No. Compartments -.----..._. <br /> Distance to nearest: Well ...................................Foundation ----:_._.._--.---..... Prop. Line ...................... <br /> 4*1 <br /> LEACHING LINE [ ) 'No. of Lines ---------__ ........._.. Length of each line............................ Total Length ..-_.._... ................. <br /> ,D%*Box ----..._._.. Type Filter Material .....................Depth Filter Material ............. ...._.__..--............•. <br /> Distance to nearest: Well ..........r.._..... Foundation Property Line ........................ <br /> --•- --- Pro \ <br /> SEEPAGE PIT [ 7 Depth __....... ........ Diameter ............:... Number .....r....... ............. Rock Filled Yes ❑ No ❑ \��I <br /> A <br /> • Water Table.-Depth .Rock Size <br /> = Distance to nearest.• Well .. .: ...._,_._.Foundation .................... Prop. Lina <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> --••----......:............p...------------ Date .................................. <br /> P <br /> Septic Tank (Specify Requirements} X . . --•••- -- ----------• � ._..... - ----- <br /> Disposal Fi Id (Specify Re uirements) R �D Tf •.•••. <br /> �` -----e-"'"'� <br /> a ------....... <br /> f ..................................... , <br /> (Draw existing and required addition on reverse side) k <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, $tate 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 be ome subi o Workma 's Com ensation la a alifornia." <br /> Signed ----------- _, - /� ----- ter <br /> ��ff ............... 7itie __._..-..---........... <br /> (If er than ow <br /> FOR DEPARTMENT USE ONLY � <br /> APPLICATION ACCEPTED BY _:_ a.._ . .. .................:............................•••------ ...... DATE 1211717.1-.............-- <br /> BUILDING PERMIT ISSUED --••---- .......................................---•-----------.•----........_.__::...._.:......:::.......DATE ...............................------------- <br /> fir t <br /> ADDITIONALCOMMENTS ....-•.................:....:.............•...-------------......._.........-----•---...............------.......------..._.........:_._-•---....._....... <br /> ...--•............:..................------•-----..._..--......--•---............_.._•-----•---------...._•-- - ---•--...-•-----•---......------------------...-•---.....--------•- <br /> ...._ � .... .._ . . ._. .. ....................... ...... . �.._.-. <br /> FinalInspection by: r ------------------•-•-- -----._-••-----•..............................Date .......... l <br /> p <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT. <br /> e u L3 24 1_•40 D_. caa 7/723 K <br />