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FOR OFFICE FUSE: <br />r------------------- <br />(7 APPLICATION FOR SANITATION PLT <br />V <br />it No.l-, g <br />;Complete in Triplicate) <br />no r Dde Issued-%6__/�_G <br />______________________________ This Permit Expires 1 Year From Date e <br />Application -is hereby made to the San Jobquin Local Health District for a per 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 />2C�Sa� S <br />sa�Th <br />JOB ADDRESS/LOCATION ...... XA5-k... Td, (Ye -----AW --•--- 9'--•-ai - .C�-rv.FVv......... CENSUS TRACT -------- ---------------- <br />Owner`s Name r S bl . rt r Phone •,----•------------------ = <br />I3�.J�, Y = .- _ ------ -- - - <br />Address _ a S� U U� }G ►�i ..- ------ ......City _. .. .....--••-------------------­ <br />----= <br />Contractor's Name _.. -- 1 l r---SF---5Qly .....................:........License #�6 :-_ter~ lx. Phone _b ��--y-'._.. . <br />Installation will serve: Residence j Apartment House -[3 Commercial :❑Trailer Court C] <br />Motel❑ Other ---------- ----------------------•---------- <br />Number of living units: .... J...... Number of bedrooms ... 3 ----- Garbage Grinder YVQ------- Lot Size <br />Water Supply: Public System and'name- ----------------------------------------- -------------------------------- -------•-------------Private <br />DO I <br />Character of soil to a depth of 3 feet: SandX Silt.❑ Clay ❑ Peat ❑ Sandy Loam '❑ Clay Loam <br />r {�p <br />Hardpan ❑ Adobe'❑ Fill Material If yes, type ---_---------------------- 1 <br />{Plot plan, showing size of lot,jocation of'system in relation 'to wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATION: (No septic`,tank ,o s i <br />epage pit,permitted if public sewer is available within 244 feet,} , <br />PACKAGE TREATMENT [ ] SEPTIC.TANK:[ j or, ` Size ------------------------------------------------ Liquid Depth --------- --- I <br />x. <br />Capacity''._' ... Type --------- ---------- Material------------------ __-- Na. Comartments"----------------- <br />p 1 _�.. <br />�.... <br />' Distancefto nearest: Well ---------- I ------------------------- Foundation.---------- ,------------- Prop. Line ..................... { <br />LEACHING LINE [ } No. of Lines ---------_-------- ------- Length of each line___ ________________________ Total Length ._..._.._......_.___......... � <br />. _ 'P;.Box,„J..__._, Type Filter Material __..._.. -_---_---Depth Filter Material ........ ............................. ...... <br />.i.�r �___ y <br />df ,.,�r...�.. f <br />Distance to nearest: Well: _ _______.._ Foundation --- ----------- Property Line ......................... <br />`"`` '-' --_ Rock,Filled Yes l Na' .i❑ •' <br />SEEPAGE PIT [ j rZ Depth -- -V ------- -------- Diameter -----'---•-...., Number,.'_'.:_....:.._._...__--- ❑ 1 <br />Water Table Depth .---:............ ----------- . Rock Size ---------_----------------- <br />$ t`#- - _ <br />Distance to nearest:. Well...-_••----�-------------T----...Foundation T -.._----_----- Prop.: Line .._:...=.--___-___-- [ <br />� .•--------------fDate -----................................ L , � <br />REPAIR/AblATION (Prev. Sanitation Permit # -----.,. ' A <br />.. la_a�. - �4.+y'' - ------------------------------- --_------------------------ <br />:": , <br />Septic Tank (Specify Requirements} -----•-- _ G �, � _.._�-------------------------------•-----:---------- :----------- • � <br />Disposal Field (Specify Requirements) 1-7r . 2/.Il.). <br />� { <br />._s Tart........i�'� �..�.=--------T�,�. o ----•---¢Ya ps e---•--... s =- --------------------- <br />..-------.----�x-------------------- <br />_ .. (Draw existing dnd required addition on reverse side) <br />I hereby certify that I have prepared this application and -that the work will be done in accordance with San Joaquin <br />n <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 />"1 cer4ify 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 became ubject to Wo an's Compens tion laws of Colifo�nia." f <br />Signed ....... L__r__2r.__ltZ \............. Owner <br />BY. ..... ...... •--•------------------------ --------------- Title ---------------_---........ ----------------- ..._ .------------ -- <br />(If other th-on_ <br />a FOR DEPARTMENT USE. ONLY <br />APPLICATION ACCEPTED i3Y . y R -` .............. - --------- -•- • ---•• -------------------• DATE ------II .. J6'� ` -(-4--------- <br />BUILDINGPERMIT ISSUED ----------- t -----------------_--- ------------------------------------------------- 1¢ ------- --....DATE ----------- _---------------------------- <br />ADDITIONA-L COMMENTS ......----------- .:...---------------- --........ ...---------------------------------------......_------- ------------- <br />__/ ---... - ­-------------- ----------------------- <br />------------- Y1 -------------- ---- <br />- - -- <br />I-- -• --- -------- .�------ ------=--------------------------- � f <br />• [ <br />Final Ins ection b Date ------ -- -` - � `- - <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M <br />