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-FOR OFFICE USE: i <br /> APPLICATION FOR SANITATION PERMIT F <br />................................ Permit No. .�3`.-�._.. <br /> Y <br /> (Complete In Triplicate) <br />............................................... <br /> ._.•........................•---._.......... This Permit Expires >I Year From Date Issued <br /> Date Issued ..�'3.......... <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> i <br /> o�,7�b =. ...p - ...CENSUS TRACT �' <br /> JOBADDRESS/LOCATION ,._......._...•... -F................. ................... ...... �................_... <br /> Owner's Name �? E: ._ ti M1R I#+ik R.........:....•-------•- z.1�.'.�be� __Phane _ ... ."..Lr ......... <br /> Address ..�5_.4a I * �._. City .`... . .......... <br /> Contractor's Name ................ :P_e[s.g-._. ..5 � ------------_--.._._....License # �- ?... Phone .. <br /> .._...... <br /> i. <br /> Installation will serve: Residence [Apartment House Commercial ❑Trailer Court 0 a <br /> Motel ❑Other ----- .......... ........................... <br /> Number of living units ........ Number of bedrooms .. ...Garbage Grinder ------------- Lot Size ............................................Y '� <br /> Water Supply: Public System and name ....Private,, <br /> Character of soil to a depth of 3 feet: Sand❑ Silt C3 Cloy 0 Peat❑ Sandy Loam � Clay Loam ❑ <br /> Hardpan ❑ Adobe'C] ,Fill Material ... If yes,type -' "'- <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be laced on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available with n 200 feet,) <br /> I PACKAGE TREATMENT [ SEPTIC TANK t I Size------_............. ............................ Liq id Depth ............................ <br /> Capacity .................... Type ... ............. . Material----......... No. Co partments .........---..........6 <br /> Distance to nearest: Well .... ...................... .......Foundation .._............... .. Prop. Line ...................... <br /> • <br /> LEACHING LINE [ No. of Lines ......... ........... L ngth of each line-_.......................... Total Length ............................\11 <br /> 'D' Box ............. Type Filter Material _'`.................Depth Filter Material ........ ............. <br /> Distance to nearest: Well ... ............... Foundation Property line ........................ <br /> .... .... .. <br /> SEEPAGE PIT [ Depth .................... . Diameter ....•._..._..... plumber ............................ Ro k Filled Yes ❑ No C3 <br /> Water Table Depth .................Rock Size <br /> -'Distance to nearest: Well .._.._ __,_.._Foundation ................ ._ Prop. Line....................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit s`# _.....__.................................... Date _._ .............................. <br /> Septic Tank (Specify Requirements) -..---- -2-- -----�Q�---- 1�`"eO .... `'' - ----------------� <br /> r <br /> Disposal Field (Specify Requirements) ............ _-=------- Q_ _--.•. 'As.. <br /> -------------------------•------------------- ................-------------------------------------------------------------------- ............... ---•------------------ ........................ <br /> ....Y_....-•---.................................................. -----------------•---------------•--•--•--------------------•- ..................................................... <br /> .- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this.application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 <br /> as to become sub'ect to Work n's Compensation laws of California." <br /> Signed ----------- ------ ---- . ....._...:.: _..__......-- ....-•••- ........... Owner <br /> By :.... ............ _4 I...._.. .......... ....... .. ....• ••• . title i .._..._........._.. <br /> -(I- -other than owner) - . - <br /> ­......... <br /> FOR DEPARTMENT USE ONLY <br /> E APPLICATION ACCEPTED BY ...... i --•-.......----•-----•..............................• ------------------- . DATE .... �.r..._.` ........ <br /> G BUILDING PERMIT ISSUED .......................... .. ..DATE ....................................... <br /> ADDITIONAL COMMENTS --• .. ....... ............ - .._.... .............I......-- ..................___._-:.... ._..... <br /> ' --------------•-•---•••••--•-.._._._.. . . ........ .... ................ <br /> ...................................... ........ ...............:... ---••-•--- ................. ...... ....................... .............. <br /> .......... .......................................... _ � <br /> Fina) In le n b . .. ._. .. .' <br /> Date ,.... <br /> —,SAN.JOAQUIN. LOCAL HEALTH. DISTRICT <br /> l ... <br /> 4 9/. - •-- _ -.. 7179 1.M <br />