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<br /> FOR OFFICE USE: tk t
<br /> APPLICATION FOR SANITATION PERMIT
<br /> �
<br /> Permit No 7U
<br /> (Complete in Triplicate) : � t
<br /> s
<br /> Date Issued
<br /> This Permit Expires 1 Year From Date Issued
<br /> Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein :i �s?S
<br /> t described. This application is made in compliance with County Ordinance No. 549 and existing'Ruies and Regulations:
<br /> [ JOB ADDRESS LOCATION .7.�- �f. . ".... /... ... ....... .CENSUS r
<br /> TRACT r�
<br /> Owner's Name ........ -CJ . t; .......................................• ... . ...... Phone
<br /> �J ....City C�. .�. ........ T i
<br /> Address ..:.... . .a. - '
<br /> Contractor's Name ... '�J%�i.•/ 'CJChir.. ........... .... .......License #%L�. ,2.9-^e. Pnone',�1�.�10/ :., u
<br /> j Installation will serve: Residence Apartment House❑ Commercial [;Trailer Court Q
<br /> Motel ❑Other.... . . .... ...... .................._
<br /> J r
<br /> Number of living units: Number of bedrooms ..3......Garbage Grinder } Z./'r Lot Size �.Z �G�► Q t = 3
<br /> r
<br /> Water Supply: Public System and name ....... .................... ..... ...............:..._...../.......:.... ....S..Pnvate$fl`
<br /> 1 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loari ❑
<br /> Hardpan ❑ Adobe ❑ Fill Material ..... If yes,type ...........................
<br /> ry
<br /> r v
<br /> I (Plot plan, showing size of lot, locaticn of system in relation to wells, buildings, etc. must.beplaced on reverse s:de.) 'kt
<br /> T.
<br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V
<br /> PACKAGE TREATMENT [ 1 SEPTIC TANK[ ] Size................:....". Liquid Depth
<br /> Capacity ............. ...... Type . ....... .......... Material. . .... . ...... No Compartments
<br /> Distance to nearest: Well . . .. .. .... .... Foundo'ion . .. .: Prop. Line ........ '
<br /> ! LEACHING LINE [ ) No. of Lines ............:....... .. Length of each line.......... .... . ......... Totai• Length' ... .. ,
<br /> 'D' Box . .. _. Type Filter Material . ........ .. Depth.......De Filter Material ..................... _.._ - - •;.
<br /> r Rock erty Line f
<br /> `'' tyi•�, ' r Distance to nearest: Well e
<br /> _ Foundation Pro
<br /> SEEPAGE olT [ ) Depth Diameter Numbe• . .. .......... Filled ,:Yes ❑ No
<br /> +f� Water Table Depth Rock Size .. . y
<br /> Distance to nearest: Well . .. .- .. . t' p. Line .........
<br /> l a 5
<br /> J Fovnda .on Pro
<br /> `REPAIR/ADDITION(Prev. Sanitation Permit# ........ . ..... ... ..... .......... Date ................... .. .. .......)
<br /> Septic Tank (Specify Requirements) ...... .
<br /> Disposal/LF/i—/eld (Specify Requirements) -� h�,� .- - ,r. . - y��,✓G' ��i� � � :'� 14,',
<br /> .. ...... .. ... .... ....
<br /> etk. 1,4 (Draw existing and required addition on reverse sidel
<br /> -;; a�
<br /> � 1 hereby certify that I have prepared this application and that the work will be done in accordanfe with San Joaquin ,
<br /> Y .,. : e 1 �
<br /> Y t t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District-."Home owner or,(icon-:
<br /> sed agents signature certifies the following: j9 �Q
<br /> r x "I certify that in the performance of the work for which this permit is issued, I shall not employ any In in such manner'
<br /> as to become subject to Workman's Compensation laws of California."
<br /> �° L 1�SYf',esYS' P r I�
<br /> Signed .. . .... . ..... .. Owner
<br /> By ... � �. . Com . ....... ... . ... .. .... .. Title .......�z;,�h..y ..- ......
<br /> 0 —fin owner) ----_- --- --- - - __-- _ -
<br /> � FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY . . .... . ... ...... . .. .... . � .�'r+...���ff��:.✓�f�''�. DATE -..lj .�L..l V v--.. �
<br /> ... . :>•
<br /> BUILDING PERMIT ISSUED .. ... ...... ...... .. �. .......r ._...............;. i
<br /> DAT
<br /> ADDITIONAL COMMENTS .. ......... .......... ..... ......_.......................... "
<br /> : . ... . .......I........... .... ...... . . ... _. . ..... . ^. .
<br /> ............................. .... ... ... .. 3
<br /> 1 .............. .. ....... . .... ............ .
<br /> .. .. '- l. r r /' ...
<br /> ;..[ .
<br /> Final Inspection by . ....... .... ... . .. _. _ ........Date
<br /> 1.� .t
<br /> SAN JOAQU N CAL LTfi
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