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T E <br /> FOR OFFICE LISt: APPLICATION FOR .SANITATION PERMIT <br /> R� ti <br /> Permit No: 3 - <br /> [Complete in Triplicate] <br /> ---------- ----- <br /> Date Issued --�-'��'-----.- i <br /> --------- This Permit Expires 1 Year From Date Issued s <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 /> ig CENSUS TRACT <br /> JOB ADDRESS/LOCA � --- M--c REVR -------- (�� a <br /> -f-l-- i <br /> c <br /> Owner's Name ------ -4 R_K..-----.7k—aw-S-0-N----------------------------------__---------------- --Phone 9_3,F_-.!.76610------ i <br /> Address ----------2 75�)_9.------�-------\11_fv_�------------------------------------ City --- --------------------------------------------------=---- ----- - <br /> Contractor's Name __6_WNa-fk---------------------------------------------------- -=-------.License # ------- -:-------------- Phone ------------------------------ <br /> Installation will serve: Residence eApartment House°❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number of living units:.__.-_--. Number of bedrooms='_-_-_--Garbage Grinder _-:- Lot Size IC - - -------------- <br /> Water Supply: Public System and name -----------------------t-------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet:-5dnd'[]- "Silty -- Clpyi ❑ Peat❑ Sandy Loam Clay Loam ;❑_r- <br /> Hardpan ❑ Adobe'❑ Fill Material -AV/-O-_- if yes, type ----- ------------------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, 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,j O <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size-----------------------------------.------------- Luid Depth ------------ ------- <br /> Capacity -------------------- TY>e -------------------- Material----- ---------------- No. Compartments --------_----------•- <br /> Distance to nearest: We I ------------------------------------Foundation --.--------- -- ------ Prop. Line __..------------.-..__ <br /> LEACHING LINE [ ] No. of Lines ------------------- - -- Length of each line--------- ------ Toial Length ---__.--------.-----_------ <br /> 'D' Box ------------ Type Fil r Material --------------------Depth Filter Materia ---------------------------------•---•------ <br /> ''Distance to nearest."Well - <br /> --------- ------- <br /> ------------------------ Foundation ------------------------ ropertY Line ------------------------ e) <br /> SEEPAGE PIT [ J Depth --_ Dia eter ---------------- Number <br /> ber ._._-____---.--__.-.----- -"- odc Filled Yes E] No <br /> - <br /> Water Table Depth --- -- -- Rock Size ----------------- ------- <br /> _ ,.,...Dista e,to <br /> ? earest: Wel --------------------------------- Foundation ------------ ------ jProp. Line -_------------------ <br /> REPA1R/ADDITION(Prev.(Pr u. Sanif"bfon Permit# ------------ -------------------------- bate ------------------------------ <br /> Septic <br /> �1-------------------------------Septic Tank (Se6 cReguiremrots) - ----- C1`} -------- <br /> ------- <br /> N <br /> ! <br /> Disposal Fi.eld�(Specify Requirements] _ <br /> NEX-19-(--,Ili A. -- <br /> `, _ _ - T --------------------- <br /> -- -------- -------------------------. p p pp <br /> ' , (Draw existing.and'required addition on reverse�sidej <br /> 1 hereby certify that I�have i're ared this a lication and ,that the work will be done in accordance with San Joaquin <br /> County Ordincnces, State Lbws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> i sed agents signature certifies the following: "_" <br /> r "I certify the e�rformance of the work for whichlthis-permi.t;is issued, I shall not employ any person in such manner <br /> as to b com bje to Wo man's Compensations of-"Californiia:'F' „ <br /> i <br /> Signed -=----"------------- Owner~.^[ <br /> BY1 --------------------------------------------------------------- - itle -r ----.-- ---------- ------- ----------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE-ONLY i <br /> APPLICATION"ACCEPTED 8Y-_ 7_�-- - 1-f`0---------------- ----------------------- <br /> ------------------ ---------- --------- <br /> ---------- DATE ----'--'_Z" 7'_ �----- <br /> ^ _ � DATE _ �"-BUILDING-PERMIT ISSUED_* �. - --- -------- ----------------------------- -- -------- <br /> ADDITIONAL COMMENTS ' -- - <br /> --------------------------------------------- <br /> " . _._ -A <br /> i • -------- _____ ---------------------------- - - <br /> �..-...J.--_.. r..+-�.. .. -------------"--------__--- <br /> W <br /> - <br /> ------------------------------- -------- _-------__----__-____ - ----- - ____- ._-_--. <br /> --------- ------------"------------ -----" -- _' --- - - ---- ---" _ ____------___-----_____------_____-_----___-_--_"-"___-5--_ <br /> __ - - r --- <br /> Final fns - b - - ------- -'--------------------------------- Date -----✓ -�/ � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />