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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> p <br /> (Complete In,Triplicate).- ., Permit Na. - <br /> ................................. •--•-- <br /> .......... This Permit Expires ! Year from Dal*Issued Date <br /> a 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> J08 A©DRESS/L AT N 4 �.._ 44. .................QMLIS TRACT <br /> Z. --- -- .......... .......- <br /> Owner's ..Name tas_4t� ........... <br /> _... _:: bys: �'~ .. - .:.:::Phone� = <br /> Nome- ... ........:.........: <br /> jAddress _. ......... ............................... .p <br /> .............I............:City ........ ------.......... <br /> Contractor's Name ? i.Uoense ill ........................ Phone - <br /> lnsta#lotion will serve: Residence&?Ap-artment House[] Commercial otraller Court 0 <br /> Motel ❑Other...... <br /> .. ............................... F - <br /> - <br /> - g ' ✓ Lot Size <br /> 6-,._�.�h.'I=='_'Number of bedrooms ...Garbo a Grinder __ ._._..... <br /> Numb er..of living -0nits ..:__ . <br /> Water,'Supply: Public System and name .............................i.........._..---.a_ <br /> ............................................Private <br /> i Character of soil to a depth of 3 feet: Sand 'Silt 0 Gay 0 ; Peat Q Sandy Loam <br /> i <br /> Q Clay Loam Q <br /> Hardpan 0 Adobe 0 Fill dater ..... ... I#y s,tyPa <br /> ............... ............ <br />{ (Piot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> I NEW INSTALLATION: f(No septic r tank or seepage pit permitted if public sewer�is available within 200 feet,) <br /> .� <br /> PACKAGE TREATMENT .[ ] SEPTIC TANK f >Se— �l.c €ze.............. <br /> ............ .. #............... Liquid Depth .......................... <br /> t <br /> Capacity _................... Type-. material......... :-----..:.::' No. Compartments ...................... <br /> � <br /> Distance to nearest: Well ..... ...................::.......foundation ...... Prop. Line . <br /> LEACHING LINE N No. of Lines, -- --.......... Length of eqch line... ��� ....' al' Length <br /> /; l/U R' Box ....f..-.. TypeIrilter Material ---7—.._•---. pep .Filter aterial ..x._.....1.9................. J <br /> Distance to nearest: Well�.'../ Foundation �� ... -:_-.. Property Line <br /> SEEPAGE PIT [ j Depth ----- ---_ .... Diameter ... Number '.._ ` Rock Filled+ Yes p - No-o � <br /> -i�V& Td le-Dept " �h yaw" �-`� Roc <br /> .Size <br /> ............. <br /> REPAIR/ADDITION istance to nearest: Well ----....._.........................-....Foundation ..... ....:........ Prop. Lin* .------.............. � <br /> a <br /> / ION(Prev.(Prey. Sonitatipn ermit ----------- Date ..................S............... <br /> Septic Tank (Specify Regtk&n s(�SJ�1-G.=-•- L71! .:.......:. ... ..............--•--.......•--.......... <br /> Disposal Field (Specify Requirements) . .rti . <br /> ----------------- L <br /> 9r <br /> -------------------------­I--------------- ------------_j.___ <br /> = ----------------------- : .. <br /> (Draw exi ing and requiredaddition on reverse side) s <br /> I hereby certify that ! have prepared this application and that the work will be done'�in 'accordance with San Joaquin <br /> County Ordinances State Laws, and Rules and Regulations of the -San Joaquin Local Heplth_District. Nome.owner or Iicen- <br /> sed agents sign u' certifies the following: <br /> "! certify that n e performs a of the w r w ch this permit Is issued, I shall not employ any person in such manner <br /> as to beco (ecfrta W a s m e ati laws of California:" <br /> Signed .. .---- : / Owner <br /> •---------- ---•-- <br /> By ----- - -----------------------•---------- -------------•--. Title --------- -------- --- --- -._- .. --lif other than owner} <br /> V, f FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - --- ---- -------- ---- ------------------�--- ..-..'-...--:. :. DATE :-- = <br /> BUILDING PERMIT ISSUED ...!....-- F DATE-•----•--•-----•----- - •--------------------...._ ...... <br /> ADDITIONALCOMMENTS ............... ........--------- ........................ -•----•-•-- - ----•---•-----------------=-------•-- --------•--•---- <br /> ------------------- ----- P <br /> =-------- --------.._ -------- ---- - <br /> ------- 4' r i <br /> •. •------------------•--.... --------------..- ...� ---_-... ..................... <br /> ---••---- <br /> ......-....- .-- <br /> Finol Inspection by: f' p # �/ <br /> -• ---- <br /> 01 <br /> J 3 2!i 1-6f) SAN JOAQUIN LOCAt HEALTH DISTRICT 8/7h 3N <br />