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r _ <br /> FOR OFFICE USE:. <br /> APPLICATION FOR SANITATION PERMIT 74% 75 <br /> Permit No. ............... <br /> I <br /> (Complete in <br /> Triplicate) <br /> �•• <br /> 1 <br /> . .. ... Ddte Issued ..eT" .. ......... <br /> s This Permit Expires 1 Year From Date issued <br /> .......... ................... ............... .. <br /> ' Application is hereby made to the San Joaquin Local Health District for a permit to tonstruct.ond install the work herein <br /> described.:This application is made in cempliarice with County Ordinance No. X49 and existing Rut+=s and Regulations, <br /> _ �G'� tENSUS TRACT .......................... <br /> it JOB ADDRESS/LOCATION o� 3 -c-' <br /> Owner's Name lf�,riC� ,�!. ... .. ...... city <br /> Yir �Ahone. ... <br /> .Address ., . .. . .....�... .. ,r_. <br /> UrensP �JSg` a Phone <br /> Contractors Name ZZ <br /> installation will serve: Residence�Apartment House❑ Comm_rcial ❑Troller Court <br /> 1 Motel (jOther .4 G <br /> y, �........... ............. <br /> Number of living units: / Number of bedrooms 3.....Garbade Grinder . Lot Size .. <br /> u.nits. Private) <br /> stem and name <br /> Public 5• <br /> Wafer Supply: . 5'/ <br /> stem <br /> of sol!to adept <br /> h of 3 feet: Sand[:1 Silt El <br /> E] Peat❑ Sondy Loam Clay loam❑ <br /> Hardpan[DAdobe E] Fill Materiol 1F yes,type <br /> __ E',,,,-,-� ---... .- - ,...--. . , -. ..-..,r.��..�.-,...•.�.-,k . .,.-.-..—.,.- t be facet; on ravens si3 . <br /> (Plot plon,.showing size of lot, loccition of system in relation to wells, buildings, rtc. mus p <br /> it ermitted if public sewer is uvailabie within 200 feet,) ' <br /> l NEW INSTALLATION; (No septic tank or seepage p' I^ liquid Depth •. .. ••••• <br /> - .. .--- Size,..- .. <br /> t PACKAGE TREATMENT [ ] SEPTIC TANK[ ] :J <br /> Material .. ... No. Compa <br /> Capacity Typertments <br /> Foundation . Prop. line u <br /> W <br /> Distance to nearest: Wel; <br /> Length of each line Total Length .. <br /> 7 LEACHING LINE [ ] No. of Lines . ............... _.... <br /> — 'D' Box Type Filter Material .... ...... ......Depth Filter Material .... <br /> Foundation <br /> . Property Lint, ...... ................. <br /> j 5 Distance to nearest: Welt .. <br /> IDiameter ... Number Rock Filled Yes No <br /> (] [] <br /> SEEPAGE PIT [ 1Depth <br /> .._.Rock Size ... ........ ............ . <br /> Water .Table Depth <br /> Distance to rearest: Well <br /> ......Foundation Prop. LI a ................ <br /> n <br /> REPAIR/ADDITIQI+1(Prev, Sanitation Permit# <br /> Date .. .. ............._.....I <br /> Septic Tank (Specify Requirements) <br /> Disposal Field: (Specify Require erste[ <br /> .t (Dro'w existing and required addition on reverse side) <br /> Ihat . have prepared this application and that the work will b* done in accordance with San Joaquin <br /> 1 hereby. certify ' <br /> County Ordinances, ;tate Laws, and Rules and.Regulations of the San Joaquin Local iieaHh District.Home owner tot, Ilcen <br /> sed agents signature certifies the following: erMit is issued, 1 shatl not employ any person in such manner <br /> i ,I certify that in file-performance of the work for which this p <br /> as to become svtiJject W n Ga ensation law: eF California." <br /> .... ..............................._ Owner <br />`.. <br /> Signed Title <br /> By (if other thon owner) <br /> FOR DEPARTMENT USE ONLY __-__ ,...�.-�--�- -•-'�"'^ <br /> s. ? _.. Jam.• DATE . �� ... .. Y ....... .. <br /> 'APPLICATION ACCEPTED BY l' DATE <br /> BUILDING PERMIT ISSUED . ... .. <br /> ADDITIONAL COMMENT <br /> Date <br /> 7� <br /> FinoI Inspection by ... . . . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/723 M <br /> E.H,12 24 1.'88 Rev. 5M <br /> ._ 1 <br />