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:7R OFFICE USE: <br /> 1 PERMIT <br /> (Complete in Triplicate) :v' -'-- <br /> N FOR SANITAYIOIV <br /> Permit No. <br /> P P <br /> s :u � l9 <br /> 4 _- `''i' ---------------- This Permit Expires 1 Year From Date Issued Date Issued -.. . <br /> Applicati :''®.'is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> des�cril:od This application is made in compliance with County Ordinance No. 549 and e xistiRulej a d Regulations: <br /> JOB DRESS/ CATION C= u•` � ----.-- ---CENSUS TRACT ----- ------- -------- <br /> N <br /> Owner NimecUZ <br /> O ---------------Phone ---------------------------••-•----- <br /> p----�- <br /> Address <br /> "`�-- �'-----------. City ----- <br /> . �& d / <br /> Contractor's NameM --------- -- - -- -- --------a-- ------.License Phone . 6 1 !_-•_ <br /> Installation will serve: Residence KApartment•House,❑ Commercial[]Trailer Court ;❑ <br /> Motel'E) Other ----- - / <br /> Number of living units:..._ ___"" Number f bedrooms .____._-----Garbage Grinder Lot Size ...I�040_._L7 ._.._._.__. <br /> Water Supply: Public System and name r-- -- ------------------------ "" <br /> . Private E]Character of soil to a depth of 3 feet: Sand❑ Silt 0 Gay E] Peat Sandy Loam [Clay Loam ❑ ;! <br /> Hardpan ❑ Adobe ❑ Fill Material IlfO_- !f yes, type _........_._Y............... : <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 see age pit permitted if public sewer i liable within 200 feet,)PACKAGE <br /> � r <br /> PACKAGE TREATMENT ( ] SEPTIC TAN Size._ . ...- Liquid Depth .._..............._...__ <br /> Capacity R.-Ow--------- Type P61- . Material_ -e '___ No. Compartments ----- ' ..---•-- a <br /> Distance toi nearest: Well -Foundati'�n _____--------------- Prop. Line ...._. <br /> LEACHING LINE DX.No, of Lines _1— Length of each line----- -------- Total Length ..,__1. -.�-------- _ <br /> 'D' Box __- _--_--- Type Filter Materia Depth Filter Material _f. --�l--- <br /> r <br /> Distance to nearest: Well _A7� ____- Fou datiori ---------- Property Line -. ......__ <br /> SEEPAGE PIT [ ] Depth --------I_-.----"-- Diameter ---------------- Number --------------------- ------ Rock Filled Yes ❑ No ,0 <br /> Water Table Depth ------------------------------------------------Rock Size ------------ ------------------- <br /> Distance <br /> = ; <br /> I # <br /> Distance to nearest: Well ----------------------------------------Foundation -.-----.------------ Prop. Line --------------...-_.-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic <br /> _.__..___------_--- -_-_._..--Septic Tank (Specify Requirements) --- ---------------------------------------------- ------------------------------------------------- •--------------------------- <br /> Disposal Field (Specify Requirements} -- ---- <br /> .. "'^ ► <br /> j I <br /> ................................................. _-_--.........._...____._...-...---` ------_-..._..-------------------------.--------..-.-..._...-------...".-..-__.-.-_----..-....._._....---- <br /> --------------- -------- -------------------------------- -- ------------------------------------------- ---------------------"',-_---------- -,------------------------------------------------ <br /> (Draw existing &n-d required addition on reverse side) F <br /> I hereby certify that I have prepared this application,andr that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of',the Joaquin Local Health.District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify thto beyc Lat inrthe performance of the work for which`this permit is issued, I shell not employ any person in such manner <br /> 9 s lett to Workm n's ompensat` rr'laws.o California." <br /> y <br /> 5is ned :f ¢,t - ����--`"t- Owner I) <br /> J <br /> r $ k <br /> BY - ----- - ------- Title --- ------------ ---------------- ------ ----------------------------- <br /> (If other hangowner] i <br /> FOR DEPARTM ENT USE ONLY I <br /> APPLICATION ACCEPTED BY ____ t �-0-------------------• ---- #- ----- - y <br /> - ---------'�------`� ------. DATE --- --'"-1 -'--��-- ------ -- <br /> BUILDING-�PERMIT ISSUED ------------- -------- � ' ��-- ------------------- DATE <br /> ADDITIONAL'COMMENTS . .. i <br /> . ,,..� <br /> - --------------------------- <br /> Y -- { <br /> --- -- ------------------ ------------------------------------------------------ ----------------------------- <br /> ----------------- ---------- <br /> ------ ---------- ------- ------ ---- <br /> ------------------- --------- -- <br /> - <br /> - ------- - <br /> ------------------------------------- <br /> F <br /> ------ <br /> - --- --- --- - <br /> Final lnspectio ----- A - - -- -------------------------- - - ------ -------Date ---- <br /> .Q <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT— <br /> E. H. 9 1-'68 Rev. 5M. ' <br />