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FOR�JFFICE USE: `FOR oFFICr ust: <br /> APPLICATfON F R.-SANITATION PERMIT <br /> (Complete In Triplicate) Permit No...7-_._.- � i <br /> .......... ...... .... ...... ......................... <br /> ......••..... ....... ......................... This Permit Expires 1 Year From Date Issued Dote Issued 5•'��/--72 <br /> Application is hereby made to.the San Joaquin Local Health District for a permit to construct and Install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> t�.. .J..?.. ' 5 <br /> -� i �— kw..0 .. ,,;,t.... ...... CENSUS TRACT....................... .. <br /> Owner's Nome.... ... ..i. - ' ����S .....Phone.151:3, <br /> N1.,..._ .-- TN <br /> ./ ��-•---- ............... ............................................City...�/��C --- .ZIP----............................ <br /> Contractor's Name.-. ...A,.I _.L 41Z-4,e. . ... _ _............... License #.,?P�-5 Phone...__:......................... <br /> Installation will serve: Residences Apartment House ❑ �.Commer Ic al ❑ Trailer Court ❑ <br /> Motel E] Other..... (t <br /> f � <br /> Number of living units:.. .-•,-S.hl um ber of bedrooms... Garbage Grinder....:.......Lot Size.......k.cy�................:............. .. <br /> Water Supply: Public System ani name)...... ....... ....��� ..:... ..... <br /> .... . .'....................................... ............. ........._........._.Private <br /> Character of soil to a depth of 3 feet. Sand E] Silt ❑ Cloy EJPeat ❑ Sandy Loam EJ Cloy Loam <br /> Hardpan ❑ Adobe j] Fill Material.. .. if yes,type..................:.---------- . <br /> (Plot plan, showing size of lot, l 11 ocation of system in relation to wells, buildings, etc, must be plcA� on reverse side.) <br /> NEW INSTALLATION: :(No septic tank•',or seepage pit permitted if public sewer is available within 200 feet,) t <br /> PACKAGE TREATMENT O SEPTIC TANK (I] Size...........tX�---------- Liquid Depth.. f�__...._ <br /> ' Q i i <br /> Capacity.�v�p�.: .t�TYPe--f'-.�e_C,9' Material •-----'---No. Compartments.........---_.. ........... <br /> Distance to nearest:;Well..... .... ....... :.......Foundation._-_-----_ Prop. Line........................... <br /> _ <br /> LEACHING LINE [ j No_ of'Lines Ul:.r._..-.-, ..Length i f each line----- t .. -- _Totol'Length ... �.. . ...... <br /> *, I ` Ar r <br /> 'D' Box �....__Type4ilter Maternal .lam-�/ pepth Filter Material......../�..................:....... . ......_. .. <br /> y <br /> Distance ,�d0 <br /> to nearest: Well./11070 Foundation.......;:::F P.roperty Line_6" -.....� <br /> iEEPAGE PIT ( ] Depth. _.... Diameter------------- = --- <br /> Number Rock Filled Yes . No <br /> .. Y..... ....... <br /> El <br /> Waterl,Table Depth �� :-.: -`......:.................Rock Size.......... - --........................ <br /> Distance to nearest: ._............... 1.. ..............Foundation.. ._ . .............. Prop, Line................. . <br /> tEPAIR/ADDITION (Prev.,Sanitation Permit#.............. .. : .......... <br /> .f.__'_.__._...._.:_.Date._.___..:_._......_... <br /> ............ -) <br /> ieptic Tank (Specify Requirements) .............. �'�'•�'�...` <br /> �. ............................._..----....-- ...----- .............................................. <br /> Disposal Field (Specify Requirements)...... .......... <br /> .....................t......._�..........;.................. . ........................ ------- --...._............... <br /> ......... ...... ........ .- ...... ' ...'R.... ^.':_ ......_.. ..........__........._........-._. ....... ._.....-............ ........ <br /> ._:. ---, <br /> i • .• <br /> (Draw existing and required addition on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County <br /> )rdinances, State Laws, and Rules and Regulations cf the 'San Joaquin Local Health District. Home owner or licensed agents <br /> ilgnature certifies the.foilowing: y <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 as <br /> o become subject to or n s Compensation laws ' <br /> of Cat9fornia."" <br /> .. <br /> >igned...... ._ ..�. ..........- C�....,........................_.._._.Owner - <br /> 3y-- .... .................... ............................ ......Title- --- - --- - ....... ---- -----.............. ........... <br /> (If other than owner) <br /> OR DEPART ENT USE ONLY <br /> kPPUCATION ACCEPTED BY Z......... DATE ......... <br /> ...----••.._.... <br /> )IVISION OF LAND <br /> _N..U._.M. .B..ER-. _-_.—__ .=:-% .............. .............-�.' .. - .-- -...---•DATE <br /> � a .. ............ <br /> kDDITIONAL COMMENTS..... ..... . .. .......... . --....._.... ........ ........ .................... <br /> ....... . . .................... •. .... .� � " : .._..... <br /> _..........I................ . ..... -. ..................... ...............................__............................................................................ <br /> sinal Inspection by:--- ._............ /•.- .... ............................... Date... ..._: .�:.r._l.. :•--... <br /> " '3 2' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> Fd5 21677 REV. 7/76 3A1 <br />