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FOR OFFICE USE: <br /> 3 y APPLICATION FOR SANITATION PERMIT .1 <br /> ............... ...................................... <br /> Permit No. .7./..��=y I <br /> 'Complete in Triplicate) <br /> Date Issued . .. �..... 7e/ <br /> ........................................................ This PermitiExpires 1 Year From Data Issued / """'"' <br /> r` 2LES--olo�3r:� <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 m e in compliance Local, County Ordinance No. 549 and existing Rules and Regulations: <br /> Ala <br /> JOB ADDRESS/LOCATI ... ... �.. . . -- 4 ..... .. . ... � !.... ..hV...........CENSUS TRACT ..... <br /> Owner's Nome <br /> ..... .. `!v". .......................... <br /> . ......' .. . . ..t................Phone ... <br /> Address T K-z� 4� <br /> � ............. .. <br /> ................................ <br /> Contrado 'sName ........... ........ . .- ...licynse�..` .... N3Phone <br /> Installation . <br /> will serve: Residence ❑Apartment ouse-El Commercial ❑Tr�ail(er Court a <br /> . . _... <br /> Motel []Other . ; hf "*- <br /> Number )f living units:.. . `r <br /> ...... . Number of bedrooms ........... Garbage�Gri�n�der�. Lot Size . Q���-........ <br /> Water Supply Public System and name . F" - :a.. _ Private O. <br /> _- '—.r-_ - �- <br /> Charactei of soil to o depth of 3 feet Sarld 0 Silt❑ Clay �� Peat ❑ Sand` Loam� Clay Loom <br /> Hardpan A�obe (] Fill Material ... . . If)es,type ...... ......... ._... <br /> �u L <br /> (Plot plan, showing size of lot, location of Sys em in relation to wells, buildings,yetc. must be placed on reverse side.) O <br /> NEW INSTALLATION: (No septic tank or see age pit permitted if'�Sublic sseewpr is avaYilable within 200 feet,) <br /> PACKAGt TREATMENT SEPTIC TANK' -X. ......_..._.i..... <br /> f ) ) ¢e.----rte <br /> �- -. .V�Liquid Depth ...�.rG�........._._.. . <br /> Capacity f7�r�` ... Type . — - - ------ ._ Mriol-ao% ' No, tCompohMertis ..... ................,��Distance to nearest: Well . _fes... !!_ .....Foundation - ----'t`......'Vrop. Line . _..-!`'..._.... <br /> } � J"pi r rr. �¢ <br /> LEACHING LINE No. of Lines .- .. 3 .,.. ..... Length of each line .. 70 - iw TotgI Length—..... ..—.v <br /> 'D' Box.,_ .. ._Type Filter Material �-^ _r fyc� f ii <br /> L4. ,,;_.Depth Filter. aterral. .. I: r.}~...._--------- <br /> r, �� , <br /> D)tante to nearest: Well ../.@0.. 1.:'__... Foundation ..../.0:.�........... Pfop erfy Line .�... _..... <br /> SEEPAGE PIT ( ] Depth .. . ... . ....... Diameter ................ Number . ...... .-..... Rock Filled Yes ❑ No C] <br /> gator TableAepth ------ --------------------------............Rock Size ... <br /> Distance to,neores-t:._Weli . _..Founda_tion Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............ ............. <br /> ..._....1 <br /> 1 jSeptic Tank..(Specify Requirements) _.......' -- .. . --- .Rafe. .. --._ .._.. .. ..-- :.�....(2A.,`.... <br /> r 'Ds 1 '(EF (4 L U ' .... .. . .... <br /> qc�' <br /> r osol Field (Specify Require nts)- .�yyn.crJ•►. !�K .�: M . <br /> ' ... . ...... r-ew.::. nn-mr.�..�::..........s..,.....n... <br /> 4' ;+a � (Draw existing and required addition on reverse side) <br /> F ereby certify 1hat:,1'haveJ%F pared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, StaSe,Laws, and Rules and Regulations of the San Joaquin local Health District. Nome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California" <br /> Signed .... ........_._... .._.... ......... ............ . . - - Owner <br /> By .... . ......... .. ....... ` . XTs..,.........................._.. Title .... <br /> (Ifo er n owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -----V..R n........... ............................. ............................------ DATE ...... ..-.L._..'.7 ........... <br /> BUILDING PERMIT ISSUED .............. ..DATE _ .......................... . .. <br /> ADDITIONALCOMMENTS ........... .. .............................. ........----------................................... . ....... . ................................._ . <br /> ............. ........................ .... .. - ..... - _am <br /> ----- ................ ......_..._.. _...-..-................... --- <br /> ----- <br /> --- <br /> *------------ <br /> ................................... ..... ......... ........ . .... _.I..... -_.. _.................. ............:....................._................................ <br /> .............. ....................... ... ---I--------... . ... .- ...--- ...---- -.._.._- ........_.............................Finallnspe r . .. .....Date ,... ". .L. ............ ,. <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> E..H.13 241-'68 Rev. 5M — __ 7/723 M <br />