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FDR OFFICE USE: .t* <br /> .................I.._.. :..._..:............F....._ <br /> APPLICATION FOR SANITATION PERMIT <br /> I Permit No. _ <br /> ..........I.._. .1:::' (Complete In Triplicate) . . $. <br /> • ----- <br /> { -- _ , Thls Iaermit Expires t,Year From Date 1s:ved Date Issued .%1,2S- <br /> Applicat on is hereby madeto the San Joaquin Local Health District for a permit to constrsict and install the work herein <br /> described. this_ -application'14 made;in,compiia ce With County O finance No. 549',and existing Rules and Regulations. <br /> JOB A©DRf55/LOCATION .. 1 CEN&US TRACT <br /> � 7 .-t.......... .......................... <br /> Owner's Name .-._. ........... <br /> ----- <br /> �. -------•-•----•--k_......................................... .._..... .......... <br /> - - � -_-.. Phone �'�7�3,��D <br /> Address _ ?..._...... lU_ rJ "�1. :._:-•••-•----•--.•...................City _:,I............ <br /> ------- <br /> Contractor's <br /> - •- <br /> c _ cL <br /> Contractor's Name .......... ..... .. '_ � .1 !-:.....................License# p 7_.:3 ..__ Rhone . <br /> lnstaltat!on will serve: Residence 0 Apartment House O-Commercial OTraller Court �] <br /> k <br /> ' Motel []Other <br /> 1 <br /> Number of living units:...__....1._ Number of bedrooms ;.�?-- Garbo e Grinders Lot Size � � <br /> Water)Supply Public System and name ----•.................•-----......_---------------... - .....�.._. �: <br /> ,,►,r..: .. ...........................Private.. <br /> Character of soil to a depth of 3 feet: SandE] Silt Q Clay ❑ Peat(] Sandy Loam 0 ,Clay Loam t, <br /> Hardpan 0 Adobe Fill Material ._..... If yes type........... ~`.. '..... <br /> �- <br /> (Plot plan, showing size ofE/16t,4ocation Y f system in relation to wells, buildings, etc..must be placed on reverse side.] <br /> Y � i�. . t �4 Jam: <br /> NEW INST)LLLATION: (No septic,tank or seepage-pit permitted If publicisewer Is available within 200 feel,! <br /> 00 , <br /> PACKAGE,TREATMENT .f ] SEPTIC TAI�lif ize............: k <br /> ,� - ... quid.' epth ....,5 ..............s <br /> 6 <br /> CapacityType -1 :.::. Material! .�'�--,No Compartments ...................... <br /> t ' 10: 9 ' . <br /> Distance to nearest: Wel{ ------...tIQ..:'I~'...............�oundatian ..--•�---„_..... Prop. Line ---._.....,�--------'C <br /> LEACHING.-LINE ( No. of lines _...._. .............__ .Length of ach line:.__ ............ Total Length ..../- :.............. G, <br /> +. ,-w . <br /> . 'D' Box <br /> Type Filer Material i .. ....Depth Filter Material .....f..g... ............ <br /> • r <br /> Distance to nearest:'Well a ... ,-- <br /> 1 _.__��.�.�_:��oundation _.�Q._.�"_..__. Property Line �_ <br /> SEEPAGE PIT �({�' De`pth”" " Daaiiieier 1�. :.._._ Number - •---....C.-•-- Rock Filled Yes r No <br /> ..... .. <br /> Water Table Depth .Rock Size - f �t 1 <br /> Distance to nearest: Well ...,..1-. . <br /> _Foundation' ' 1..4{.sx..... Prop. Line ..-�....... <br /> REPAIR/ADDITION(Prev. Sa�itotion•,Permit# f Date -----------....................... <br /> Septic Tank (Specify Req fir'"-ents)..... ---- .. <br /> - - <br /> } -... ---------- . <br /> Disp al Field ( e 'fy Requir m nts) l i - ....................... <br /> - - -- --------------------- t <br /> -------------- ----------------------------�• -----------------------•- -------­----------- ----------------- -- ------------ <br /> ........ <br /> ••................ ....................... <br /> t <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, acid Rules and Regulations of the San Joaquin Local Health:District. Home owner or Ilcen- <br /> sed agents signature certifies the fallowing: <br /> "I certify that in the performan�a of'the„work_for:.which I�Iiit:permit is-Fissued, I shelf not employ any.person 1n such manner <br /> as to become subject to Worlmgn's Compensation .laws of California.” <br /> Signed / _ / ---- . . _.•------------•---••- ------------ --- Owner <br /> By -- -----------------v-..--- . - <br /> •- -- ---------- -----••--------- -•-••--- title -------- ... <br /> (if oth t an owner! <br /> R DEPARTMENT IISE ONLY <br /> APPLICATION ACCEP ED BY __ =;- •-• -----5Gl-14/—f-I---- ------I_---------------------• DATE .�-/,4-_:_7 -------------- <br /> BUILDING PERMIT ISSUED .. ............................•-�----------•----- -----_-----.DATA -ADDITIONAL COMMENTS ._---.` %' .... . ....... . ...... <br /> r <br /> ---.,...•------------------ r <br /> Final Inspection by: ---- ----.-Date ... ._Z.O_. . ................. <br /> EH <br /> 13 22t 1'6 v• 5Mr SAN JOAQUIN Q L H ALT DISC TRICT 8/74 3M <br />