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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> _..................................-...n -, 7 / ... <br /> (Complete In Triplicate) Permit <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for 6-permit to construct and install the work herein <br /> described.This application is omplit}nce with County Ordinan+e�No,;549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIOIQ 7 " �'�.: .'.-- TRACT __a .�....._._. <br /> Owner's Name _..............L/ Va _}n .rr+aaw�o�c.... �i9.U..l.S......'---Phone.............__.................... <br /> I <br /> Address ...-/3.`l ar '� .......�`.. 14A.L�N. ... - ................ ... <br /> Contractors Name ....... ; ...`----.----- .....- °........--............License # ....S.-..l.../....... Phone -----.__................... <br /> J arcInstallation will serve: R sidence�ent House j] Commercial❑Trail ours=] <br /> r L. <br /> Motel C Other , ..._.......--.................. t ......... <br /> Number of:living units:---I-------- Number of bedrooms ...Garbage Grinder 5k &Size D�....... Pr..� �........... <br /> Water Supply: Public System and name ......._ -......-.._i.............. ............ t ............... Private [ <br /> Character of soil to a depth of 3 feet: Sand) ] Si CJ Clay C Petit(ji Sandy loam fl Clay Loam Ze_'` <br /> i`' <br /> -Hard ,tin Adobe CJ Fill Materiat-cl.4t:C7:c If y 4,type-. ....... <br /> (Plot plan, shoeJing size of lot, location of system in relation to wells;buildings, a must be placed on reverse side.) j <br /> NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sewer is availdj3le within 200 feet,) / { <br /> PACKAGE TREATMENT [ ) SEPTIC TANK Tt .•! Size....//f.Xit�..x.-S_ .-_- Liquid Depth ....�............... <br /> ... <br /> Capacity I2QQ... Type PF{CF!4-8- Materidl,.�KCKJrt tt No. Compartments -.. --.Zi --.... t ' <br /> Distance to nearest: Well ..i...25Q-......*-_.......:'Foundation ._TIO.. ! ------ Prop. Line .-.w?..: ~.....� . <br /> LEACHING LINE [Yr No. of Lines ------ ..... 'Length of each lines_. ...Z5_..... <br /> Total Length .._,l.J�.�............. <br /> • D' Box)ES. Type;.Filter /Material d ... _ Depth Filto Material ...._19......... ................. <br /> Distance tonearest: Well< Q Foundation ----- . .....'f Property Line. __ ........ <br /> SEEPAGE PIT Depth ..)j......_---- DiameT r 3i.�... Numbgr, ._.....................__ Rock Filled Yes No [] <br /> n� <br /> R Water Table Depth j-ft.0..... ._.....\_.._...--_.JI�.N����__ock Size 1✓.y ... Z.�� -- / <br /> Distance to nearest;wan ...... >......,��.... -=lFoundationi..../Q.......... Prop. Line :f�?............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit#`..... ......................... ,... Date ..................................J <br /> Septic Tank (Specify Requirements) // -- ...._.........-- <br /> Disposal Field (Specify Requirements) .....................-............------------ ...............1=--------------__............_........--------!............... <br /> ---- <br /> / fv1C05i43C1 <br /> ............ - - .......--- ------- .-,----------------- -- ... - ---------...... -... .. - - ................. <br /> a\AI Taw✓✓4 t <br /> ---------- -->-------------_.. v€- -- -: - --------- .-..- - -�' -. ..:... ......................... <br /> _, - _ -• rk..i jDraw existing and required-addition onseverie�sid6It 43 <br /> r r`i 2 1 <br /> I hereby certify thacl7rave Xpared--this_application-and-that-lha w:Ick-yvill_ba dens in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules dnd Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the foll�wing: <br /> "I certify t a n the performance of ithe work for which this permit is issued, 1 shall net employ any person in such manner <br /> as to bec m subject to Wor n's Compensation laws of California." <br /> signed - -5`h�_.. ..A_/LV /. I............... ......... ......... Owner <br /> (If other than owner) e <br /> ,. FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... !A_- ----- -•----..._.-.........tt3?:ltf._..-tttit.taFS...... n_Q-u_u.;DQ7El(.... .'L -- �P----------- <br /> BUILDING PERMI—T(S�QE ------.- -- -- - -. ._._. _ r _ -- <br /> ..DATE---'---...---- - - - <br /> ADDIT-I0M COMMENTS---::. __-. ..:..- - n.� .-�.,....:.:. : .. re� o .:r. ...... .........:. .. <br /> • -- t�1 -F�:1 T: - ,"s'st t 3 cam:=. . ci -....... ...._... -- ._...... <br /> - ......... - -- <br /> Final Inspe : .. - ......... ............Date ....... -- r.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i <br /> 1 E. H. 9 1-'68 Rev. 5M <br />