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FOR OFFICE USE: APPLICATION FOR SANITA QN PERMIT <br /> ----- -- - - --------------- - - - Permit No. ..1.!Z��.�1. <br /> (Complete in Triplicate) <br /> ....... <br /> This Permit Expires 1 Year From Date Issued <br /> --- Date Issued 'P..7.• <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 /> k _ <br /> 706 ADDRESS/LO TION <br /> -- t --- - --------------- -- --- CENSUS TRACT <br /> �j - • �! _tI__ �i56.L�t` trf�R -----._Phone V64--' / -,....... <br /> I Owner's Name �1��"7 -- -- --��- - �-f-- ------ <br /> Address .- ----- ...�/..�...... . , — ------ ------ ----- --- City ----- --------------..--.--------••- <br /> Contractor's Name -` ----------- -- --.License #/x,51%- Phone <br /> k <br /> Installation will serve: Residence ❑Apartment House Commercial❑Trailer Court C1 <br /> Motel E]Other ----P-------- ------•---�,- 0 <br /> Number.of living units:............ Number of bedrooms ------------Garbage Grinder -- ---- Lot Size ...........--------------..-._..._._.._--_ <br /> Water Supply: Public System and name --- -•------------•--_ --------- -------------------------------------- -------------- .............Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑F Silt❑ Clay ❑ Peat❑ ` Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan E] Adobe_❑ tIf yes, typ <br /> Fill Material _......_._. � ................._-- _.___ <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 TI �No sept tank or seepage;p t�permittedli-f public sew,er�is•'available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size'.__ . ................... Liquid Depth ...�.a�— ------.---. <br /> i t ._ No. Compartments .._��— <br /> - Capacity --�-------------- Type -��{� Material_. - - ............... <br /> { Distance to nearest: Well ----------- f-._.- ------Foundation ------ Prop. Line ---------- ....... <br /> LEACHING LINE No. of Lines .-.___-.._ff_length- of each line-.__t . _ . ---- Total Length .............. <br /> 'D' Box ....-� Type Filter Mate(, )COT. Filter Material _..._f ...............�.-------•----- <br /> Distance to nearest: Well -- - ---------------64,,Foundation, _�_ Property Line _.-f.....�'_........ <br /> SEEPAGE PIT z 'Depth ....Z$-_- ._. Diameter-t' _. `r fl <br /> 3 __...._ Number: .... ._____= -- ock Filled- Yes No <br /> fiable Depth _' --------- ---- ._..Ro 1k Size ��-------- <br /> Water ' /-�------ <br /> ' • f �' [ ,� O (� Pro Line j-��7;±7.---•.... <br /> Distance to nearest: Well ..._.......`.__.....................F,oundation .1_... p. <br /> REI IN(Prev. Sanitation Permit# -.__-_-----.------_ ------------------ -- Da�Te' ...._..--------------........._) <br /> J1� Y <br /> eo <br /> Septic Tank (Specify Requirements) -------- ----{14_ _--'•=--•--••.... <br /> Disposal Field (Specify Requirements) ------------•----------•-••.....--•------------------------------ ------------------------------------------------ <br /> - <br /> ------ .-._..---:-c;.--.-. � <br /> J" ­-------------------- ---- ••-•-•-- . . •. ........................................----- <br /> --- - - -__ . _ <br /> -----•-- -----• ------------ ------•-- - - -- --------- --- --- ------------_------- -----•------------_ -------...... <br /> ._._ <br /> I <br /> (Draw existing and required.addition on:reverse side) <br /> t • y .t} rte, <br /> I hereby certify that I have prepared this application andf-:that Jthe'iwork;will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules 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 issued, 1 shall not employ any person in such manner <br /> I as to become subject to Workman's Compensation laws of California." <br /> Signed r ---- -- ------ Owener- <br /> B ( '� ----- ---- --------- - - - -...- ----------- <br /> ' .�'•` _" f other ri"owner)`-'--�-_ ..�.� <br /> ARTMENT USE ONLY. <br /> APPLICATION ACCEPTED BY ........ ;:- -•------------------- ....... DATE Jr �G;7;?_ <br /> 1 BUILDING PERMIT ISSUED Z. `sr �t#'':=`J:.}::e --... .........DATE <br /> - -- - - ------ - - <br /> ADDITIONALCOMMENTS ...•. -- - - - ------ ----••--------•--- -----•-----•---•_----------------------•--------•-------....... ------- -------- -------- <br /> z <br /> - - - ----- -- -•-----------------------------•---------------------•••--........ <br /> *...................... __-------------- <br /> FinalInspection by. ----- -- ............................................................... Date ------` '�3 <br /> x <br /> AN AQU1N LOCAL HEALTH DISTRICT <br />