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.. --•--.- wx VrrlGt USE: <br /> APPLICATION FOR SANITATION PFUMIT <br /> ....................................... <br /> `/ (Complete in Triplicate) Permit No. _.......... T�... <br /> .... This Permit Expires 1 Year From Date IsO Date Issued .9: :7 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constlifct an4;e;?cnd <br /> all the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Regulations: <br /> JOB ADDRESS/LOCA N ..sa�.3c U t. S4o21 ................................CENSUS TRACT .......................... <br /> Owner's Name .. ..................................r...... Phone .................................... <br /> .......... <br /> ........... <br /> Address _._...... ?�Q.?. ..... ... Fence'IU�!f <br /> t-- City .. ... YL .._ � ..:........ <br /> /�- ........................_. <br /> Contractor's Name ... tc�rk: -_.` .... .....License #ltyc�( �(' ---. Phone ......................_. <br /> Installation will serve: Resipartment House❑ Commercial❑Troller Court 0 <br /> Motel ❑Other........................................ <br /> Number of living units:......1.... Number of bedrooms .....` ...Garbage Grinder ............ Lot Size ................ <br /> Water Supply: Public System and name .................................--•--.-_---.-._----........_............._..a--•-....�......Priiv e � 7(•✓ <br /> Character of soil to o depth of 3 feet: Sand❑ Silt❑ Clay ❑ Pea} Sand Loom CI Loam WO <br /> Hardpan�/ Adobe❑ Fill Material ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ah. must be placed on reverse side.) v <br /> NEW INSTALLATION: No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK(17! Size. ...d l ...X-C. . ...v?H. .. Liquid Depth .... ...?T <br /> Capacity . ...... Type _�tr a u�_ Material.---'t s'.. No. Compartments -.:2/...T�.-._... ' <br /> �/ Distance to nearest: Well ..............�r._�.A--.-------Foundation ......1- ? ... Prop. Line ...�'�ir^...-..... <br /> LEACHING LINE [t7 No. of Lines .......2-.--.-.-.-.._ Length of each Ilne. ?ii ....... Total Length ... j ._._. <br /> 'D' Box ../........ Type Filter Material ....SI.Z.......Depth Filter Material ...../5.. ............................. <br /> Distance to nearest: Well .......��k..... Foundation ..../..� ....... Property Line ..�` ............ <br /> SEEPAGE PIT <br /> [ ) Depth .. Diameter .../,�..Z....... Number ...........05............ Rock Filled Yes a No O <br /> r. <br /> Water Table Depth 0.1K!I..lt'.0.�..........................Rock Size ...�. a.:.x..3........... <br /> Distance to nearest: Well .......1.Q.Cs�---------------Foundation ...LD..111----- Prop. Line ......a <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dote .................................. <br /> YYY <br /> Septic Tank (Specify Requirements) _...._..............--••--............---••-................. <br /> DisposalField (Specify Requirements) .............................._...............----...........................--------------- -- --------------..............--- <br /> ---- ....... . .............. ..............................•-----------••-_....••-....................•••.............•••--------------- ....-----............. <br /> .... .. ........ .......... . --...---- . --...----....._..... ..............-..... •-•-------------.......•••-••------•.......••-••------•------....--............................... <br /> [Draw existing and 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 /> 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 .... . - ..._..................--.- . . _ G�__ '- - title . Ca -. <br /> . ............................._ _. <br /> (If other than owner) <br /> _ _ p FOR DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .- .. L '- . --.... . ............. ...... DATE 8131!1.24.................. - <br /> BUILDING PERMIT ISSUED ..................................... . .. .......... .......-.........DATE .......... <br /> ADDITIONALCOMMENTS ...... ........ ..............................................-..----------...........-----......:_..._...:...............!.. ................... <br /> ......_.................._....--- ............. .............................. ............................. ....... ...... ............................................... <br /> .. ............. <br /> .... ... .... <br /> FinalInspection by: . �,. - ... ..- . .. ........_....._.........Date .. .. .----_. ....................... <br /> EF{ 13 24 1-68 Rev. 514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7a jM <br />