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FOR OFFICE USE: <br /> Gt <br /> _ "eAPPLICATION FOR SANITATION PERMIT <br /> i _..... .._ .......... <br /> ..../3...,LG=G[ �...... .1/�."..��... .(e <br /> (Complete In Triplicate) Permit No. ¢ <br /> Date Issued ; <br /> ! ................_....................................... _ This Permit Expires 1 Year From Date Issued ,K <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 compliances with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .. /.'.-....7._.. ... .2............ 7........ �./.yj SUS TRACT . <br /> _ oyit(....... ..y..�.jy...�.r.. /q ... <br /> Owner's Name .....M .q.-. '-...........LY./-L.9J...�L.1..�........ /�. �L.r.::Lh <br /> s _ . . ne ............................._..... <br /> Address ----.........._...._.. !7.. ........................................._ ........City �L�K.Ctpllatiarz.�/,..__..._............__ <br /> Contractor's Name........ t�.L...`..... ............. ......S ..r...........License$ . fb.�EPhone".Y.�.��...Jr..Z7� <br /> Installation will serve: Residence[2,Apartment House❑ Commercial ❑Troller Court ❑ <br /> Mote[❑Other............................................ <br /> Number of living units:.... ...... Number of bedrooms . <br /> 9v_7.._.Garbaga Grinder 170... lot Size ..../0 4....Z`.../ZJ.:C1...... <br /> Water Supply: Public System and name .. ........... .................._.. ................... .......................................... ..Private ; <br /> Character of soil to a depth of 3 feet: Sand E✓Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ <br /> Hardpan❑ Adobe ❑ Fill Material ............If yes,type ........................ <br /> (Plot plan, showing size of lot, location of system 's relation to wells,buildings, e,r. must be placed on reverse side.) v ;: <br /> NEW INSTALLATION: (No septic to or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( 1 SEPTIC TANK[ ] Size...._............................_.... Liquid Depth . _.__............._... <br /> j . � ± <br /> ;... Capacity .................... Type .................... Material...................... No. Compartments ``. <br /> , ...................... <br /> Distance to nearest: Well ...................................Foundation . .................... Prop. Line...._._............. <br /> LEACHING LINE [ ] No.'of Lines Length of each line---------------............. Total Length ..._....... ....... <br /> • D' Box ...... Type Filter Material ............ _.Depth Filter Material .. ............_..................- <br /> Distance to nearest: Well _ ............... Foundation ....... _ .--- Property Line ........................ <br /> SEEPAGE PIT [ ] Depth ._. ......... Diameter ... Numbe _... ................. Rock Filled Yes D No ❑ {. <br /> r: Water Table Depth ................................................Rock Size................................ <br /> Distance to nearest: Well .......................................Foundation .................... Prop. Line ........._........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit#............................................ Date .................................. <br /> ) ` <br /> Septic Tank (Specify Requirements) .....a.............. <br /> Disposal <br /> 'Field (Specify Requirements) .............✓],-------1S.0.X.............4lJ✓6............�.0............. <br /> ....KJ4'.Tl(v <br /> ;-i <br /> '.. ..... ..................................._...._..... .. . . ; <br /> ..._..._._ <br /> ................ ..._.._. __.... _.._._.. . . .:...... _................ . ......... ................................... <br /> i Drow existing and required addition on reverse 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 ReP:.tations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: - <br /> "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws,of California." <br /> Signed g _ ....... .... . .... Owner <br /> By .._.. _� _._. Title. <br /> (if other than owner)._. ........ _ _._ ......_..__.... ...... . . t <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED' BY _...... _ i.- ............ ._......... ................ DATE ..._. .(.�..-.V.._..._...._._ <br /> BUILDING PERMIT ISSUED .............._____......._.........................................................................DATE .......... <br /> ADDITIONAL COMMENTS ... ....... ..._._................................._....----................. ....�_ <br /> .. ._.... ...... <br /> ... ... .._... <br /> . ........ ........ <br /> ............. . <br /> Final inSaeCtian by. ..1.... .. .... .. .. -L . AL... ...... ..... ...... T......... Date...l0' ---- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1"'68 Rev. SM -.� <br />