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FOR OFFICE USE: _ <br /> ��APPUCA7iON FOR -SANITATION PL..4J417 <br /> (Complet ipli tel r• Permit No. .-<................. <br /> ............................... ..........I......... 7�S _ <br /> `........................... ..-....... This Permit Expires i Year From Date issue <br /> a 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 smode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .... r J!`!.�S.T. p4 l{!` `E......................-........-...........--..-....CENSUS TRACT ...........:...:.:.. .... <br /> p _ <br /> Owner's Name .............i�.. .. .._.. s...c..------........-•-- ..............................................:............Phone Ali�f?.':`t� <br /> P Address ............. <br /> rr•• ,,, // City f ca c �a�1 <br /> _..... �' .r_`F...:.w i .-.-f-?pr°`? ......• -.--• ------------- -------- ...................-................................................. <br /> ..... <br /> Contractor's Name •----.--. a?- is .: ..... ............. ... .........License # ----_------ .......... Phone .46.6 '.��7.... <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 <br /> 11 Motel []Other ..........................•--..........._ <br /> Number of living units...._ ---.--- Number of bedrooms ..�--'-'._......Garbage Grinder ............ Lot Size ... ................ <br /> Water Supply: Public System and name ---................................................... .........................................................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay .I] Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan [] Adobe.[] Fill Material ...-........ If yes,type _..----...............­­_­ <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public se er is available within 200 feet,] V <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ ) Size................... ................... Liquid Depth ........................... <br /> CapacityType ..... Mater ... No. Compartments ....................... <br /> Distance to nearest: Well ............................. . ...Founds ion ..__--- -------------- Prop. Line ....__......._........ <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of ea line.---- - . . .......I-----. Total Length _-------.--..:.............. <br /> D' Box ............ Type Filter Material ......... -_-•--- . e th filter Material --------------._...........___•------•--._-- <br /> Distance to nearest: Well ...........:. .......... oun is i n .....- ................. Property Line ........................ <br /> SEEPAGE PIT ( I Depth ..-_--------___ Diameter ._. .. ... 1 . Nu �r ............................ Rock Filled Yes ❑ No 0 <br /> r <br /> • Water Table Depth ...................••. ... • ................Rock Size ............••--•. ............. <br /> Distance to nearest: Well ................ .... ..................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -_----_---------------- . ............... Date .................................. <br /> Septic Tank (Specify Requirements) -------------------. ............... .........-- -- ...._......... ................................... <br /> Disposal Field (Specify Requirements) � ---- <br /> -- 2r. t(Ce,�—,. �`± 4�p, -- e?a,I ...dV-'----. ............... <br /> ••-•------------------------------------ ••---- ` pr`�� "'T ----- ------- --------- --.._ . <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 far which this permit is issued, l shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> t Signed ------- -•-- ---------------••-----......•--• --------- Owner <br /> ax-- ---------------- <br /> BY -•------------------- Title --� <br /> (If other than owner) ...... ................................................ <br /> _ FOR DEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED BY...... .... ......................................... DATE �`- •- -- _-• <br /> BUILDING PERMIT ISSUED ........ _ _ .................••• ••-•••.....................DATE ........................................... <br /> ADDITIONAL COMMENTS .........................................•--••-- - <br /> ....-------•---------------•••----•--------•-............_..----•-......---------------------------...-•------..............•.. ........................................ <br /> ....................................................... ....... <br /> ...........................................................•-•-------------------........---• ...........------...---•...................................-.......I................. <br /> Final Inspection by: ........:._ <br /> --• ...••-• _._.Date <br /> SAN.JOAQUIN LOCAL HEALTH DISTRICT <br /> c E. H.13 24 1.'68 Rev. 5M__ 7/72 3 M <br />