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FGR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> jf1 °' 3''rre �. i Permit No. --TL x°-6__2 <br /> t <br /> (Complete in Tr;plicate) t <br /> a <br /> 1P n_•- Date Issued --- <br /> This <br /> -fThis Permit Expires 1 Yea 2-from Date Issued <br /> Application is hereby made to the S n Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Or a inance No. 549 and a sting Rules and Regulations: <br /> JOB ADDRESS/LOCATION .--- ---- � °1 a�S ------ =------------ '. CENSUS TRACT <br /> Owner's Name �� 1' ALL: -------- -E-�- 3 ------------------------------------------------Phone <br /> Address ---------------3g-Zt-7-----� --------------------------------- � City ��_c.k-''��----------------------------------------- ------ <br /> P 40t-J-- 7—4./C <br /> Li, nse # �!--14�7­75�-- Phone A--- --------------------- <br /> Contrac <br /> - ------------------------------•--::.__..-- <br /> Contractor s Name ------------ --------- ----------------------- -------.L ense # T1_$-- -`! Phane {_ <br /> Installation will serve: Residence partment House❑ ommercial ❑Trail&,,Cdurt i❑ <br /> Motel ❑Other -----------------------I-------------------- <br /> Number of living units --- Number of bedrooms ____�____Garl6kage Grinder�_�J__._ Lot Size ---S-Z-4 ------------------- <br /> Water Supply: Public System and name _"�-4-rA - '- - �----4'~ =----------------------------'---------------------Character of soil to a depth of 3 feet: So ndPrivate <br /> El <br /> ❑ Silt❑ Clay F] Peat El Sandy Loam ❑ Clay Loam ❑ <br /> Hbrdpan ❑ Adobe-{N, Fill Material _ -- If yes,type ----__.___----------------- <br /> a�� >s <br /> (Plot plan, showing size of lot, location of system in relation to wells,Fbuildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank <br /> k or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK'od Size______r/,Y.Q�C- ---- ---i-- Liquid Deptht lX-_-------------- <br /> i" It� Materia`I-0,-, Np, Compartments __D----_-_ . <br /> Capacity ---- Type lLc� <br /> Distance to nearest: Well ____---� -_________---'-Foundafiion /_a-------------- Prop. Line s______:__._..-- <br /> a <br /> LEACHING LINE ,} No. of Linen -- --------------- Length of each line_. )----6�-- Total Len h 1_7 4 <br /> 'D' Box �,j-____ Type Filter Material -ul-_----- Depth Filter Material __,c_ _- ----------- <br /> ---- -- - - ------------ <br /> Distance to nearest: Well ------------------------ Foundation ---------- --- Property Line _Z-!.----------.----- <br /> SEEPAGE PIT Depth 5)- __________ Diameter , _ _____ Number __-___�------------}--- flock Filled YesNo 1' <br /> p 1 1 4. t' <br /> Water Table Depth -------4D 4-P--------------------------­ -Rock Size ��L.��------------- � <br /> 'x "°._"...Foundation vJ-------. Pro Line -.------- -- <br /> Distance to nearest': __:__ ____"___.______;_..-- - r --� � p• - ------ <br /> REPAIR./ADDITION(Prev. Sanitation Permit'# ---------------------------I--------I-Date -------~-------- ------------- <br /> -------------- <br /> ------------ <br /> i <br /> Septic Tank (Specify Requirements) l EE = ----------- I------- i----------�_ f)------------- -------------------- ------ <br /> Disposal Field (Specify Requirements) k----------------------------------- <br /> ,.. -----------•--•-- I------- --------- ----------------------- ----------------------------------------------------- <br /> % ,. f <br /> -----------------------------------------------------------------.-- -----_-------------------- =---=- ---- - --- - __y <br /> --------------------------------------------------------------' --° t-------------------------------------------------------------- <br /> -------------------------- <br /> (Draw existing and required addition on reverse,side) <br /> I hereby certify that I have prepared this tapplication and that the work will be 'done in accordance with San Joaquin <br /> County Ordinances, State Laws, andlRules 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,issRued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California:"., I <br /> Signed ------ )other <br /> --------------------------- - ------------------------------------------------ Owl <br /> _ i <br /> By ------ = - ------------ ' <br /> Title a <br /> t than owner) . ; 1 <br /> FOR DEPARTMENT USE ONLY <br /> 1 DATE `7 <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED ------------------------ ----------------- -----------------------------------------DATE ------------------------------------------- <br /> ---------- ----------- - <br /> DITIO COMMEN --- ..... A- -;Il ; tAIS ?`. -= - ----------------- <br /> f ----------------- <br /> y.. 7; -------- ---- <br /> Final Inspection by: . i= i'-------------- - ------- -------------------------------------- <br /> ----- -------- - ---------------- ate ----- ----- -- ------ <br /> - -- ------- <br /> - sD <br /> '1 . LZAN.LIOAQUIN`'LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />