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t µ; <br /> KT„ <br /> FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERM <br /> .............................. (Complae in Triplicate) Permit No. .._�3..757 ` <br /> ..... This Permit Expire%1 Year From Date issued Date Issued., <br /> [moi <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work h�iefn <br /> described.This application is made in compliance with County Ordinance No. 549 and existing Rules and Roqufa►Hansj , <br /> ' JOB ADDRESS/LOCATION <br /> ..Co.t�Q_..,...CENSUS TRACT _ <br /> Owner's Name :_.., .. .. . � .... .�. ..$. rL <br /> Address ,._CC� .M . Hhone � r�'ltd L} �,I <br /> ... ; <br /> ........ �... Gey r��t� <br /> n( pti , <br /> Contractor's Name �.. .... ..141ne <br /> . Pho <br /> lnstaliation will serve: Residence EkAportment House[] Commercial oTrolfer Court ] <br /> Motel o Other <br /> " � Number of livi _. . <br /> ng:units... .. Number of bedrooms Garbage Grinder ..... .. Lot Size.:.,Ac.,q " <br /> a*p Water Supply:'Public System and name ...-..... <br /> _. ..... <br /> k <br /> l <br /> Character of soil to a depth of 3 feet: Send ""•"""••"' -••_•••• ..._ Prirote <br /> )] Silt[� Cloy [3 Peat p Sandy Loam Clay Loam 0 �! <br /> Hardpan[] Adobe❑ Fill Material.... .....If yet, r ' <br /> (Plot plan, showing size of lot, location of system in relation to wells, bulidin s,.etc. mush t u <br /> `NEW INSTAULATION: {No septic tank or seepage ,t 9 be placed:,on revers«Sti�e} <br /> apag p' permitted if public sewer is available within 200 feet,)All, <br /> PACKAGE TREATMENT [] SEPTIC TANK <br /> [ Size......................... ...... liquid Depth <br /> Capacity Type Material....... <br /> No.- Comp <br /> • Distance to nearest: Well partments <br /> ......... Foundation. .._:._ Prrop:LEtte...aa.h � <br /> LEACHING LINE [ 1. No. of lines Length,of each it <br /> Tot <br /> al Lengfh ..t of <br /> D' Box'. ,. Type Filter Material <br /> ....................Depth Filter <br /> Distance to nearest: Weil .. Foundation <br /> ., -• Property`Line <br /> SEEPAGE PIT [ 1' DepthDiameter t <br /> ............:. : Number Rock Filled <br /> Yes <br /> Water Table Depth <br /> ..Rock Size. <br /> f Distance to nearesh Well ...... Fo <br /> Propundat <br /> RENUkADDITICN(Prev.Sanitation Permit# Line <br /> ........ .... <br /> Septfc Tank'(Specify Requirements) . . . Date ..... <br /> ......... } V <br /> k'Disposal-Field (Specify Requirements) .......... ........... . <br /> ._.i..... ............. <br /> . ........ . . ..._......_ . ........... <br /> (Drdw existing and required addition on reverse side) <br /> 1 hereb}► certify that i have prepared this application and that the work will be done in accomence'.with SaR 'Jao,utn <br /> -County Ordinoncis; State Laws, and Rules and Regulations of the San Joaquin Local' Health Di=%riot.Hinre ewner'er(ipti: <br /> 'r-ed agents signature certifies the foliowingn # <br /> "i awdfr that 16 tho:perfornsonce ef.the work for which this permit Is Issued I shall net ami n <br /> p h►a }►Mrfat Im such enpnneir <br /> as., became subject to kman's Compensation laws.ef California." <br /> 5lgned r .�` <br /> Sy �%J• . _ Owner <br /> [/ <br /> r <br /> 11f of er than owner) Title ,.. <br /> FOR DEPARTMENT USE ONLY <br /> J. 'APPLICATION ACCEPTED BY, . 3 �'— <br /> a�. <br /> BUILDING PERMIT ISSUED.. . .. . •• <br /> DATE ,�`!`?.2. <br /> ADDITIONAL COMMENTS <br /> DATE <br /> .... . .....................•.. ..... .. <br /> f .. <br /> nal Inspection by: . ..........:.... .......... „ } !?�;' <br /> �{... <br /> (J 7 ....... <br /> .............. ......... . .. .......:.Date . Q.. <br /> SAN JOAQUIN LOCAL HEALTH TRICT } <br /> H.13 241-,68 Rev.5M <br /> ;�� .. �, 7/72 3 M E F <br />