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FOR OFFICE USE: <br /> r OPLICATIO14 FOR SANITATION PER' <br /> -�. _ -- �SC.-- � �' -� Permit No. <br /> (Complete in Triplicate) <br /> cDate Issued <br /> --- This Permit Expires 7 Year From Date Issued <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 madames in compliance withCounty Ordinance No. 549 and existing Rules and Regulations: <br /> �- JOB ADDRESS/LOCATION 6 f - - L(_- S-fd—a__.__I',�f--s-------------------------.------CENSUS TRACT _-.--.----_............. <br /> /-- ------ --- -mss J <br /> Owner's Name ------------ -A• '---------ice✓-- tr�1J -------------------------- Phone ....... <br /> Address ------------- ------ <br /> - /--d e3_0_ --------- City ------- --------------------------- <br /> Contractor's <br /> --- -- -- - ----Contractor's N ----------------License --- Phone <br /> Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court [] <br /> Motel ❑Other-------------------- ------__------------ <br /> Number of living units:-----1---_ Number of bedrooms _-3._ Grinder . ---------- Lot Size .-_S-. __-z ___-_-__-- <br /> Water Supply: Public System and name -------------------------------------------------------____--------------------_----------------------PrivoteX <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ � <br /> Hardpan ❑ Adobe)( Fill Material ----- ------ If yes, type ---------------------------- 6N <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> D <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> .. PACKAGE TREATMENT [ I SEPTIC TANK 5jze.___ 01 0 <br /> __xk.------_-------------.- Liquid Depth 5 ..._-------- <br /> Capacity <br /> .,...-. <br /> Ca act - Type _ e-.e.l_._.... Material...e..414a No. Compartments �7® <br /> Distance to nearest: Well ___--_.-._-Foundation ---IO.f--------- Prop. Line <br /> .f P -- __-_ Total Length .1.Zt�_`- <br /> LEACHING LINE No. of Lines ...__.__. <br /> � ---. ��__-__..-_ Length of <br /> line___ __�_...--___.__ <br /> 'D' Box --_`�.-_ Type Filter Material lw p ` <br /> Depth Filter Material -----/.- -_...---------..�-.--,--=-- <br /> Disttance to nearest: ellme D,t------- Foundation :--�_ -.j..... Property Line ... ............... <br /> �r <br /> SEEPAGE PIT Depth _ -___-_ 3---_----- Number ---- ockFiU;d Yes No �] <br /> Water Table Depth .------ ---------------------------------------Rock Size <br /> Distance to nearest: Well ---- .................Foundation ---- __:'Prop. Line .-. ...... <br /> REPAIRJADDITION(Prev. Sanitation Permit# ------------------.__.._...---­---­---.. Date ---------------__--______-_____) <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) <br /> ---------------------------- ---- --- - ----- --------- - <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <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 /> "I 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 _.- . ------- ---- - --------- Owner <br /> By - ---- c ----/` - -- - --- - -------------- Title -------- -152t -----------------. .... ----....- <br /> If other n owner) <br /> EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ -. __ . ..._ ----------- DATE _- <br /> BUILDING PERMIT ISSUED -._.-. _ <br /> ----- --- -- -- ------- ----------------------------------------------------------DATE --------------------------------------- <br /> ADDITIONAL COMMENTS ---- -- - - -- -- - ----- ----------------------------------------------------------------------------...-------- <br /> L - ----- ----- -- --- - --- --- - -------- ------------ --------------------------------- --- <br /> -------------- <br /> ---------------------------------------- ----- ---- - ---------------------------------- ------------------------------------------------------------------------------------- <br /> --- --- ---------------- --- ------_-_----------------------------------------------------- -------------------------------------------------------------�` -- -------------- <br /> FinalInspection by: -- ----- - -- - - --- ..........................................-.. ....... -------------------Date ---- - <br /> ' JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 R . 5M <br />