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C) <br /> FOR OFFICE USE: <br /> !✓� . �s/ <br /> r7Za. APPLICATION FOR SANITATIO14 PERMIT <br /> Permit No _ d os <br /> >. <br /> „. _.... <br /> (Complete In Triplicate) <br /> .... . ... ....................................... is Prnnit Expires I Year From Daft Issued <br /> Date Issued...� T <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work hsraln <br /> described. This application is made In compliance with County O►dinance No. 540 and existing Rules and Regulatlonsr j <br /> JOB ADDRE!5ACICATION - Z I Q3_1. Y..G�..G11.-T H,Y-...R� ....CENSUS TRAGI <br /> owner s blame ,M r;-../�oH .. l�roo./hr.�i� _._........................ .. ............ •......... <br /> r: Address .Z,// .'V...D�GIf Tart e< Acd... . . ....... - ..... City ._rnc•f J�vl _........ _. <br /> s Contractor's Name .p.A-rrl.i.�i....>f"...So. S...............-" ...................Lkense# <br /> Installation will serve: Residence j�rtment Housefl Commercial j]Traller Court fl <br /> Motel 0 Other <br /> Number of living unitsi...f-..... Number of bedrooms ....2...Garbage Grinder ............ Lot Size .3D....X�.D4.. ........... <br /> { Water Supply. Public System and name ..................................................-----—-------..__...............I.....................Prtvcft <br /> Character of soil to a depth of 3 feet. Sand❑ It Q day j� <br /> eat 0 Sandy Loom❑ Clay Loam 0 <br /> Hardpan[Adobe❑ Fill Mcterial ........--.-If yes,fypa <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be planed on reverse s1de.) <br /> NEW INSTALLATIONt (No septic tank or scepage pit permitted if public sewer is available within 200 feet,! <br /> PACKAGE TREATMENT { ) SEPTIC YANK( ] Size....».......................................... Uquid NO <br /> Capacity Typs . Material...................». No. Compartmet- <br /> Distance to rAwrests Well ..............................".....Foundation..................._.Prop.Lina...».._.......Y W <br /> LEACHING LINE O No. of Lines . ...................... Length of each line............................ Total length ..-.._.»..».. x <br /> 'D' Box .-:... ..... Type Filter Material ....................Depth Filter Material ...........................� <br /> •� Distance to nearysth well ........................ Foundation .........---............ Propor Property <br /> ....... » (I <br /> SEEPAGE PIT ( J Depth .................... Diameter ................ Number ............................ Rock Filled Yat © No C3A <br /> Water Table Depth ..........................................._.._Rock Size.................. <br /> .»..- <br /> Distance to nearesh Vhreli ........................................Foundctlon . ...........". Prop. Lire ....... <br /> HAIR ADDITION(Prev. Sanitation Permit#........................................... Dote .................._........... <br /> ) <br /> Septic Tank {SptafyRsquirements <br /> ) ............................................. .............................. .............. -........-- - .» <br /> /� n <br /> Disposal Field (Specify Requirements( .....f. ...�`.........� ....... .. ,t <br /> 13..A�,r...�......0.�.1�.........31..'. ...y�....,.r.'.... -...................................................---._._.._..............._................. :. <br /> ............................-..............I........... ............. .................... ........................ .»...............................»....-..........._.- <br /> (Draw existing and required <br /> .sedition on reverse side! <br /> I !hereby certify that I have prepared this application and that the work will be done In accordance weds Sees Josgrbt <br /> County Ordinances, State Laws, and Rules and Reguiatlons of the San Joaquin Local Health Dislrkf.Home swear or Nat} <br /> sed agents signature certifies the following- <br /> ­11 <br /> ollowing:"i coMfy that In the performance of the work for which this permlt Is Issued,I shill net employ any persaa In swh ahmtster <br /> es to become subject to Workman's Compensation laws of California." <br /> Signed .... . .................. ................ ......... ...................................Owner_ <br /> ........................... _.. title...t�S7�/y►7A4}�.�. .. .... . ._ <br /> If other than owneri <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY. ------- ................ ........ ... ...-........-.... ...... <br /> �.. . ............... <br /> BUILDING PERMIT ISSUED -..-..- .. . ......,......................................-.........I.....'... ...-.........DATE . .- -- . ............-...._..._....... <br /> ADCITIONALCOMMENTS... . ... ..................—........-..--...-.-.... --... ....- -......-....... -.-..-. . ........-........................-..__.. <br /> E .............................. ---- -- --.....-............ . ...... .....,._.-.-..---.._.__..-........ ...-.......... <br /> r7S , . r. .. .. .-.. .............. ..-.... .-..-........ .. - ... ........ ...-._--..-.....-.... .---....... <br /> i .......... . . ... .. ................ ....... .... .. .. .....-...I... ...... .. ...... ........ <br /> i{ Final Enspect;on by: -....-... �... Dote . .......-_.._.. <br /> ' £! 13. 2h 1-69 1 OA IN LOCAL HEALTH DISTRICT $/7�D <br />