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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />.......... .......I...................... Permit No. 7y`939 <br /> {Complete in Triplicate) <br /> .........__ - Date Issued /a-17-7/-/ <br /> -• i <br /> This Permit Expires 1 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 /> F <br /> JOB ADDRESS/LOCATION ........ / ......... ............... ..............CENSUS TRACT .......................... <br /> Owner's Name ....... y_...... s X.,F1.G.......................................................:.... .........Phone ..............,..................... <br /> Address ......................... ...................................... City .......... i / ......................................... <br /> Contractor's Name ..... Y ........s ....License # ......................... Phone <br /> installation will.serve: Residence PfApartment House Commercial QTraller Court 0 <br /> Motel Q Other............................................ <br /> Number of living units:_.__.... Number of bedrooms _.?........Garbage Grinder .... ....... Lot Size ../�?.....�1 ....�45?.......... <br /> Water Supply: Public System and name ............................................. Y.:.................---................:.......Private' <br /> Character of soil to a depth of 3.feet I Sand b Silt Q Clay 0' Peat Q Sandy Loam 0 Clay loam ❑ <br /> Hardpan Q Adobe <br /> 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 240 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ I Size......................:— . Liquid Depth <br /> l <br /> Capacity ...:................ Type .................... Material-••.............•--... No. Compartments ...................... <br /> Distance toI nearest: Well ..................................:.Foundation .._............ ...... Prop. Line ...................... <br /> LEACHING LINE No. of Lines ...• :/. ... Length of each line_----- ....... Total Length ........... <br /> D� 'D' Box .YiO�... Type Filter Material s..�J°�'l.4�Depth Filter Material ............ . .. . ....................... <br /> Distance to nearest, Well ./.1a_/...__..... Foundation ....... Property Line .....+,.f <br /> SEEPAGE PIT X1 Depth ..... � �" Number .............. ... ........... Diameter ... �... .... Rock Filled Yesft Na 0 <br /> Water fable Depth ...... .......... <br /> •------:......Rock Size -� :.. <br /> ..• <br /> Distance to nearest: Well ---------X49!2....................Foundation ...... Prop. Line ......�............. <br /> 4 <br /> REPAIRAM309COW14rev. Sanitation Permit ......:........•......•............:......•• Dote -................................... <br /> ) <br /> SepticTank (Specify Requirements).__.:......:................................ ................................. ............................................................... <br /> Disposal Field (Specify Requirements) ...................•/ � �.....---- ._.._.. =X� 1�u.(i'.__..... ., ? .----.. <br /> ---------------------------------------------------------- -----•--....._ ................ --•-••------•-.................... ....... ............... <br /> -_---_.•_----_•------•----------•........................ .......................•-• -•--- .: ....................................................__....................... .............. i <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San .Ieaquln <br /> County Ordinances, State Laws, ani Rules and Regulations of the San Joaquin Local Health:District. Home owner or Ikon- <br /> sed agents signature certifies the fallowing: <br /> "1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in tach manner <br /> as to become subject to Workman's,?Compensation laws of California." <br /> ul <br /> Signed _._..�� � rl_ _._...... ���-w4--- -------4-11;._........ Owner <br /> t , <br /> By _... Sitle .. .......... ............ ..---- -----.........-........... <br /> i �(_lfother than ownerl <br /> FO EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �I ....... DATE lU .I7. ?.f ............. <br /> BUILDINGPERMIT ISSUED ---- • -----•-------------------------------- ....... --.DATE -.._.._._................ ............... <br /> ADDITIONAL COMMENTS ---------- !----------------------•------ --•-----...-----......:.........................................-... ..........:...................... <br /> ..... <br /> --------------------------------------------------------- ----------------•-: - -----------------------..._...-.................... <br /> ---------------------------- - •----------...-- ._._._...-........---- --------.....-------..-...-•••--------•------------._..__......_..- <br /> --------- --------- •-------- _ ....----......---•--. ... .. —--. .-..Date .6 <br /> Final Inspection by: . • r ... ---• ,/� �' <br /> ' Eli 13 2)t 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 31'i <br />