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J - -- <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: <br /> (Complete in Triplicate) <br /> ..._..J...v........................................... , n <br /> Date Issued _r6.:1- .-�7 <br /> This.Permit Expires I Year From Date Issued <br /> Application is hereby made to the San Joaquin Local}Heolth District for a permit to construct and install the work herein <br /> described. This application iss/ma//de,:iinn compliance with;Countty�Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA ION _.- '`�0 � ......--....CENSUS TRACT . ........................ <br /> ----•-•.Phone 44*n� -- <br /> Owner's Name - ---• � - -- { --- ........ -•-- - •••- - <br /> city �Z`( . ------_---_--_---- � <br /> Address . `Q 7r" - f ,/ 1� '> "�".A!� 11DT <br /> Contractor`s Name ._._ �/ R _.-.License Phone 804• -.-_7---••--•-•- <br /> x ... ----------- --------- -------- <br /> 1 ; <br /> Installation will serve: Residence 94brtment House'❑ Commercial:❑Trailer Court �7 <br /> Motel ❑Othe;--- --------•---•------••---- •.............. <br /> Number of living �niffits:... ___-. Number of bedrooms .i Garbage Grinder 4AP.. Lot Size ----- <br /> Water Supply. Public System and name ------------------ Private <br /> PP _.._t............. <br /> i <br /> Character of soil tc a lepth of 3 feet` Sand Si If Clay ❑ Peat❑ Sandy Loam ❑ Clay,Loam,0 <br /> Hd'Fd�an ❑ Adobe-❑ Fill Material ..... If yes,type-.•-•------_-----•---•---- <br /> r buildings, etc. must be placed on reverse side.) <br /> [Plot plan, showip? size of lot, location of system in relation to wells, <br /> NEW INSTALLATIII N: (No septic tank or seepage it permitted 0yublic sgw�r ids/avai ble within 200 feet,) �� i� <br /> / X.L�.�-..; -�--------- Liquid Depth •-----•-- <br /> PACKAGE TREATM4=N� [ 3 SEPTIC TANK�6Y � t Size__ ...- <br /> 1 Capacity/,;ZpV- -•• Type =-318-- MateriaLCQ-*1C. W_TR No. .... <br /> �Compartments __ ....... <br /> I / s <br /> Distance to nearest: Well �__ ._..._.......__......Foundation -- --- <br /> Prop. Line- •-- <br /> f I _- � g � Ste.-------- <br /> LEACHING LINE '}r No. of Lin' i Le?�gth of each line._...�/� -- iota! Length ._..0-... <br /> t �� <br /> 'D' Box .11...- Type Filter:Material AC -•.--•De Depth Filter Material _ _J?..----••-•-•-•....................... <br /> i ' <br /> Distance tnearest: Well _. .----------- Foundation 1Y................ Property Lire ____.p----------- <br /> 0 .• <br /> t <br /> SEEPAGE PIT [ ] Depth .............._-... Diamete�--------------- Number ....--.-----.._.-.._.•-.__.. Rock filksd Yes ❑ >[] <br /> flfo <br /> Water Table Depth ......... .............•........Rock Size ................................ <br /> -Distance-to-nearast:-aNe11 �..._------------- ---------- ...........Foundation .................... Pre -- <br /> Line -•----------------- - <br /> �- - - <br /> REPAIRJAZI6ITI04Prev. Son-,Mcion Pe"rmi 51�""-. - ``'................ ....••... Date <br /> Septic-Tank (Specify Requirements) - �-------------------- ...........}•-,.-..:- .... -- <br /> �.. <br /> �t - ..._..- <br /> posal Field {Specify Requirements) <br /> = .' („_tet ........................ <br /> ............... ................------------......... ------- <br /> ------------- •---------------------------- ....._.-•-•- -....---•---••-•-.... ... ----------------- ---------_..----------------------------------------------------•----------- ---•-------- <br /> (Draw existing an4 required addition on reverse side) <br /> I herepy certify that l have prepared this applicati"'' and that the work will be done In accordance with San .Joaquin <br /> County Ordinances, State Laws, and Rulex-and-Regu6ons.of-th*4*n-Joaq n Local Health District. Home owner or liven- <br /> ! sed agents signature certifies the following: <br /> "I certify that In the performance of the ork For which this permit is issued,i shall not employ any person in such manner <br /> as to become sub)ect'to Workman's Comp sation laws of California.".< <br /> Signe - Ctwner <br /> ------------ -- <br /> -� >.t Title , w7 ,�-, -• f -J!C1!! /✓ <br /> BY----- ... F...._ -- ------ <br /> _----- - <br /> (If other than owner) ' <br /> �'FOR­DEPA'RT-HENT--USE•-ONW c <br /> APPLICATION ACCEPTED BY-_77.7K 9'---F_p1?- .0_.... ................... •-----_---. DATE �3?/ 1� ---_--------,- <br /> BUILDING PERMIT ISSUED ..........' ----- • - ---------------••---.....DATE .._._......_.._........... ---•--••--- <br /> ADDITIONAL COMMENTS ............R.................. ........... ............................... :._....... � <br /> k - = i-•-•-•---•- <br /> ............. ..................................... .....------- -• -------------------. ----........---•-•---• _. ._ ..� <br /> -- --------------•-=-----------•-------------------•----------------------•--------------------------------------------•--------................................... --.-�`..•` -- ,. <br /> a_ - <br /> FinalInspection by: .- ..................................................• -••-•--•-•--••------.Date <br /> _SA N_JOAQUIN.LOCAL.HEALTH DISTRICT <br /> �i �. <br /> 1�1 L ':wM.. `•V.Frww. <br /> E. H. 9 1•'68 Rev. 3M• <br />