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2 OFFICE VSE: <br /> f=i APPLICATION fbR SANITATION PERMIT <br /> ( Permit No. .7,S-S <br /> (Complete In Triplicate) <br /> ..............................•-------.--•-------....._ --Z <br /> 7s Y� <br /> This Permit Expires 1 Year From Date Issued Date Issued -7.._� .�,� <br /> Application is hereby made to the n Local Health District for a permit to construct and install the work herein <br /> described. This application is e i am� pplianc ith County Or in ce 544 a o e i tin Rules and Regulations: 1 <br /> I <br /> L� <br /> JOS ADDRESS/LOCATION Is. ................ .�...�P�.�a--- ------ --- -- ...- -.......----....0 SUS TRACT ....-----------........... <br /> Owner's Name ............ Safi ---.....,..�. _.. oU ............ <br /> Address "`_ �. ._ ".- . .. -- r- <br /> Ph one 7 7¢ <br /> � ...... --� : ..w-µ-�- -. - ------------- •---...: .._................. <br /> ' n C'ty <br /> Contractor's Name ........................ __. .. -- <br /> ...I._._..._...._.�.:.,... �:._._: E icense # �3 �.------- phone 46.107........ <br /> I <br /> Installation will serve: Residence Ri Apartment House-❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑Other . t,4,,�' <br /> Number of living units ..... Number of bedrooms __._...Garbage Grinder .._.__..._ Lot Size .SQC� <br /> Water supply: Public System ind named; '. ...-z-';vv.......;._'t:�}.._..-•----- # --------------------Private ] <br /> s.wYrt.'-_ 4 ...................... <br /> Character of soil to a depth of 3 feet: Sand b Silt{❑ Cla`y ❑ Peat❑fes Sandy Loam ❑ Clay Loam ❑ , <br /> Hard ant Adobe Fill Ma terial)...._�...... If yes, type ----------- ---------------- <br /> (Plot plan, showing size of I t, location o y.stem-.in relatiof►-to '*3it S, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or�seepa9p.pit permitted if public sewer is available within 200 feet,) rr -� 1 <br /> t <br /> TREATMENT ( ] SEPTIC TANK jib i Size_-.._�_ . .' cif-_..�.._.............•._..-. Liquid Depth _.. •---..__._.... I <br /> PACKAGE t� � <br /> J a - - C.Ef'uc%.-.- No. Compartments <br /> Capacity .fes ._ Type Material... tet, <br /> f . <br /> Distance to,rtrest- Well . ,. ...... --------------------Foundation _...1Q. ...... Prop. Line -..5__.._..____.... <br /> LEACHING LINE tA No. of'Unes �_.. Length of each line -� � 0 g <br /> f �- - �--- Total Length ..�. _.... <br /> �� <br /> DAB Type Filter Material .. .---..Depth Filter Material -/9—..............................._.. <br /> istance to nearest. Well .._____�[[b_ �,.- Foundation .................. Property Line .... ................... <br /> SEEPAGE PIT ,/' Depth �� -_._I!_ Diame er '*!e4U __._ Number _._......, '............. Rock Filled Yes ( No 0 i <br /> t -ttWaterjo.b.I.e.Depth' - -----------�"�s,A----- ......._Rock�5ize. ,l l _ .- <br /> , <br /> Distance to nearest: Well .......... ....�- <br /> . .--...---------.----__ Foundation .... Prop. Line ............ <br /> REPAIR/A DITION(Prev. Sanitation Perrltmit --------------- <br /> # -___--......� 4.-.���� .. .................................... } <br /> --- <br /> I <br /> Septic Tank (Specify Requirements) . . -. .. ' _. ...... i <br /> Disposal Field {specify Requirements} ......................... ..----------.....---• } ... ........ ............... ---- 9 <br /> ............ ......... I... - ; ---- ---- --...-. --... ............... ................. ....... ------------.------------------ <br /> (Draw existing and reg6ired addition onlreverse side) <br /> 1 hereby certify that I 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"3an.to::pJqut;hILocal Health District. Horne 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 issued,--`l'shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> ! 1 <br /> Signed . ... --------- ---- .. ....... .............. --------------- -------- Owner <br /> By .... �./...W r ............ .. .............................. <br /> (If of r than owner) <br /> FO&ODEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY YW - �------- ........ ....... .............-. .. DATE -. <br /> BUILDINGVPERMIT ISSUED .....X. _. . .... - _. .................... DATE -... ..�v <br /> • --------�'...-= .._..... ......_....... ......_..-----........__ --•--•----•-- <br /> ADDITIONAL COMMENTS .......... -- ._>-- ----------- -----. ,. ... I <br /> .......--- ------ ------ . ..--•- �....� J <br /> --------------------.....-...L.F__. .Alt- --------- <br /> ->-. ......... ............... . . ....................................•--•----....__ <br /> .. ...... <br /> --------------------Date . ' r- `...�--•-~- <br /> •-•--- <br /> Final Inspection bY '��' SAN JOAQUIN LOCALALTH <br /> tDISTRICT <br /> c u 1-3 21L <br />