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'-,,:-.,•ORa01~fICE t1S1r. ..._,_....... ..�.�.__ <br /> I- APPLICATION FOR SANITATION PERMIT <br /> {Cam late in Tri Ileatey Permit No. .................•--- <br /> p p �- <br /> ............... This Permit Expires ] Year From Oafs Issued 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 /> / s�. vA-10ry <br /> JOB ADDRESS/EOCATOqq O. ...._. ........... <br /> .._....._W_ :_ _ ...........CENSUS TRACT .......... <br /> Owner's Name ..-_. r... ` - •............:...... Phone _ <br /> Address -------- <br /> . w~ ... ...........•••- <br /> .. ------•- _..----• ",.. <br /> - _ -_s:.,�.:.---- -•--- ---__.. City... ... _ ------------=-----•-- <br /> Contractor's Name o 'ffliG 2 ---------------------------------------..-License # ;2 Phone _ + <br /> M <br /> Installation will serve: Residence 10 Apartment.House fl,Commercial CITrailer Court 0 } <br /> � , <br /> ' Motel E]Other - <br /> ..................... <br /> �... <br /> Number of living units:___ 'Number of bedrooms <br /> ...Garbage Gunder------------- Lot Size ------- ...................•--�----•---- <br /> Water Supply Public System and name ... ...........--- -------........------ --------------- •........ ......Private <br /> Character of soil to a depth of 3,.f <br /> eet. Sand 0 Silt.❑ Clay ❑ Peat❑ Sandy Loam 06 Clay Loam❑. <br /> 1 Hardpan [j Adobe [] Fill Material ............. If yes,type ............... ....... <br /> (plot <br /> f <br /> (Plot plan, showing size of lot, 161 cation of system in relation to wells, buildings, etc, must be placed on reverseside.) <br /> t NEW INSTALLATION: (No septic tank or seepage pit permitted If.public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK] Size... .Y.• -----_---- Liquid Depth <br /> .......... <br /> Capacity <br /> i 1 , <br /> Capacity G'' _- Type iQ 'a3 Material__.•_----•--------_-_ No. Compartments ..�--......._ <br /> Distance to nearest: Well 40-V F <br /> _ G <br /> I _ f . _ -. --------Foundation /----------------- Prop. Line -0-7 ......... <br /> LEACHING LINE [ ] No. of Lines - ____•--. ----- Length of each line__•_-,/--lam_•p__-__-... Total Length ...021 1..'........ <br /> 'D' Boxf.../, ..... Type Filter Material 1,ZOxz Depth Filter .Material ..-_X�..._-•------------- --•-•_--•. <br /> l _.. <br /> Distance to nearest: Well .__�.�_.��`+-.:;� Foundation .............. Property Line ...... <br /> SEEPAGE PIT ( j Depth .............. Diameter ..... '" Number ............................ Rock`Filled Yes No <br /> Water.Table.Depth -...::::::...::<;•. Rock Size <br /> ..................... .. _.___:... _.-__........_..4� <br /> Distance to nearest: Well ----------------------------------------Foundation =..:_:�..�.::_:. Prop. Llne .....:_._.........._.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .............. ------------------------_---- Date ...... ---'---;i.=•--------) <br /> Septic Tank (Specify Requirements) .........-.._........ ............ <br /> .._..................... _ _ ' <br /> ------------------------ <br /> Disposal Field (Specify Requirements} -------- <br /> i <br /> _ t <br /> ------------ ----------------- <br /> - ------------------------------- � ----------------------------------------------------•---: ----------­ ----------------- <br /> g (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- <br /> sed agents signature certifies the following: J , <br /> F "I certify that in the performance df the work for which this .permit is issued, I shall not employ any person in such manner <br /> as to become subject on's o pensation laws of California.,, <br /> S � <br /> Signed -------------- ------------------- --------------------.- Owner <br /> ...�.z ._.r .. - . . ».r.�..,.. <br /> '� ""'... title _ <br /> (i'f o#her than er <br /> own ) 0 #. <br /> ..__. "FOR-DPARTMENT USE. ONLY_ <br /> APPLICATION ACCEPTED BY ---------.._ _ -• _.. . �� <br /> DATE <br /> BUILDINGPERMIT ISSUED ----•------ -:__ • ------------- ----------------------------------------------------------•-------------DATE ................ ...... -•----......... <br /> ADDITIONAL COMMENTS ---- ------------------- <br /> III 4 <br /> Final Inspection by: ............ !.. C ©ate ._...q--,.� `� <br /> f� ---- - <br /> IrH 13 24 1-613 Rev. 5'I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />