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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br />......... ."...-."........."..-"....................• <br /> Permit No. �. �•- <br /> (tomplef,..e in Triplicate) <br /> Date Issued -."...1:�:�.`?:� <br /> This Permit Exports.1 Year From Data Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit 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 /> JOB ADDRESS/LOCATION .:...../.Q "�•fD ES?''._.tLr-�4-!`�G..R -_.._..... ..... ........... --.CENSUS TRACT ....................... <br /> Owner's Nome ......"....... AeflN." ............. <br /> ........... �.Phone ...L1�' 3..'.7v��.la. <br /> .5'020,.... Ss L ."."............ -- ... city -.SC3' ` '."4�r Z�."`a""...._..-.."................... <br /> Address ................ - <br /> Contractor's Name ...... 42c� -------- -------License # - -----3Phone <br /> Installation will serve: Residence [AApartment House-[] .Comm�erciol'❑Trailer Court ❑ i <br /> Motel❑Other ... <br /> Number of living units:......[..... Number of bedrooms . .--.._Gariiag Grinder ..,."+._.... Lot Size ..1-tG2.y. -1- <br /> Water Supply: Public System and name .,....._... "-". •- -.---.--------•--..-----. .."Private <br /> it <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt[I Clay ❑ Peat❑ Sandy Loam F] Clay Loam ❑ k <br /> Hardpan ❑ Adobe Fill Material ---......... If yes,type ........ ................... <br /> (Plot plan, showing size of lot, location of system_.in,relation to weils,..buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public.�sewer is available within 200 feet,) <br /> ..... .- .....".... <br /> PACKAGE TREATMENT SEPTIC TANK Size - ... .. Liquid Depth p <br /> . .._ <br /> nts .:-.. <br /> ...capacity Type MaterialNo. Com artme <br /> Distance to nearest: Well ....;q.. �-..----..-"....----..Foundation...."_1. ---_-_-_- Prop. Line So".d'--•--- 0 <br /> LEACHING LINE ] No. of Lines .. ... •, .... L•endth of� ach line .... J+o�?.- ". Total Length ...."Id.Q..---....."--. e <br /> 'D' Box .1. .- Type Filter MateriaiV-1 .�'M1e� -Depth Filter Materia! _L$. .............. , <br /> Distance to nearest: Wel! _._.5�).--' --- Fo'undation ..:a o '�-...... Property Line -`f--=--•.•--- <br /> piameter Number_,=_..�........ - Rock Filled Yes �t No O <br /> SEEPAGE PIT { � Depth ..... --- -kms _ .... ..". <br /> Water Table Depth ...... ' _�.r------•--•- ... : }. �1 -... <br /> - Rock Size`"� r � <br /> on �0.�. .. Pro Line .--...------------_-- <br /> Distance to nearest: Well ..-......�E__Z ..." ..............:--Foundation p• <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............... .............................. Date -------.-""-- -;•..---••) <br /> Septic Tank {Specify Requirements) ------ ......s................. ............ ......... <br /> Disposal Field (Specify Requirements) .- ---------------------------------------- """' "'---- ............ i <br /> ....."........................... •--•-- . <br /> .............. . ................. ----- -------------- --.....--- :_... ..- ................ ......... <br /> ..- <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 i <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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 orkman's Compensation laws of California." ` <br /> Signed .:.. ... - ." Owner <br /> By "... . .. ._.* <br /> ................................. <br /> Title . <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY Ta <br /> ,,._� ._. . r...a.._}✓....."- .. - <br /> APPLICATION ACCEPTED BY ... .". .- //-.--- ---..... DATE <br /> BUILDING PERMIT ISSUED .. . __ . " :... DATE - . ._. ---- " <br /> ADDITIONAL COMMENTS ..�. .�3 _Pi .- ... ----- di`' L�! ... ." _ ; <br /> ---------- ------------- ----- - g <br /> :� -- .... o::�i :.::.. y' -- ..----•------ -----. <br /> ..----- ------.-..". <br /> .... <br /> yy� nn •. Date ..-. .oz.. .. .. <br /> Final Inspection by. ..-_�G�r--- ------------------ -----------<..--.- .: ------•---....�---------•-••-.-..------ --•-- '�� <br /> SAN JO LOCAL HEALTH DISTRICT _ <br /> 4 , .f 7/723 ,1 <br /> u L3 24 ,_ Asa std„ r,m <br />