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.--K wrriLC u5E: <br /> .............................. ..... . .. ............ APPLICATION FOR SANITATION PERMIT _ <br /> 1, ......... <br /> ............. <br /> ..... <br /> {Complete in Triplicatel Permit No, 7S `7�0 <br /> a ........ <br /> •............... - Thls pe <br /> rinit Expires 4 Year From Date Issued <br /> Date issued •la��.�l,-• <br /> Application is hereby made to the San Joaquin.lcca) Health District fora <br /> described. This application is made in compliance with. ounfy Ordinance Na. 549 and existing Rules and RA <br /> permit to construct and install.the work herein <br /> t <br /> JOB ADDRESS/LOCAT o Regulations: <br /> s ��. • s'-' .'. - ..•.. . ............Owner's Name . CENSUS T <br /> ......_ ....... <br /> Address .._._. ,..::......:..:.... t <br /> ......_..,.... ` <br /> i :..__..:._' a ......................... <br /> City, Y-o <br /> 4 on <br /> I Contractor's Name t..--------------•--•--• .._._... ---..... _ ._..... " <br /> installation will serve: := License ? 1j5....... phone _.�j� ,f /t <br /> Reside icg• par%.- House{]iCon,mercial#]Frailer Court ] <br />` ..._,_,."•..."Motel'[) �'' <br /> F Other............ <br /> ............................:` . <br /> Number of living units:-------_,1 Number of bedrooms. <br /> Water Supply.. p -� Garbage Grinder y,, ,(i; Size:� <_, <br /> P Y= ublic System and na / ••.....•--......... <br /> me , <br /> Character of soil to a depth of 3 feet: ��_- - •........••••• <br /> _�� •_- •--•--• -....' ..-• Private <br /> Sand ❑ Cl Y ❑ Peat <br /> ❑ Sift ❑ Sandy.Loam ❑ Clay Loom <br /> ..�Hard an� <br /> P C) Adobe Fill Maaterialt <br /> If Yes,type ... <br /> (Pias plan, showing size of lot, location of system in lotion to wells, buildings; etc. must be placed on reverse side.) <br /> � <br /> NEW INSTALLATION: {No septic tank or seepage�Pit permitted if public sewer is avaiiable within 2Q0 feet,} e.l <br /> PACKAGE TREATMENT [ ]l :,SEPTIC TANK y } ....._--- :. ,Liquid Depth .---•--- e I <br /> c co . <br /> Capacity -------- Yp Maternal •... ` ... o. Com <br /> N partments <br /> Distance. to nearest: Well ?--------- Foundation .............. <br /> ......- ......... .. ...:..... Prop. Line .--•---...............� <br /> LEACHING LINE [ ] No. of.Lines <br /> .length of.-each_line................ ..... Total Length ................ <br /> 'D' Box' T e filter Material <br /> f YP ateriaf .---- „-------Depth .Filter Material <br /> Distance to nearest;-'Welt <br /> .-......-----••----.`--- Foundation <br /> SEProperty Line .............. ....... <br /> SEEPAGE PizDepth' .�J � --•�-----•• . .. <br /> [ 1 .............._. _ f:.:----,FDiameter •-- <br /> 3. Number _.. .............•...... Rock Filled Yes No ❑ <br /> Water Table;Depth ----•------ ....................................Rock--Size . <br /> �m!,2i <br /> Distance to nearest: Well .__4?0. ..._._..._•_ - <br /> RhPAlR/ADdITlOIV(Prev, Sanitation Permit# ......._.__... __-- Foundation ._�R2�:.•-,.._• Prop. Line _.��.'.�:,,. ' <br /> I Da <br /> Septic Tank (Specify Requirements /� ............... V, <br /> -f- <br /> Disposal :..:... <br /> _..-• Field (Specify Req.uirementsj <br /> -- t <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 <br /> County Ordinances, State Laws, and I;vles and Regulations of the San Joaquin Loc <br /> sed agents signature certifies the f6llowing: of Health,District. Home owner or licen- <br /> } <br /> "I certify that in the performance`of the work for which this permit is issued, I shall not einploy any person in such manner <br /> as .to become subject to Workman's Compensation laws of California." <br /> Signed ---- ------- -- ----------------•-- --- •--•---_.� - <br /> --------------------------------------- Owner <br /> By __------------ f " <br /> I <br /> of e than owned f <br /> ---••-----•--- Title <br /> - 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... <br /> BUILDING PERMIT ISSUED _.. ...........................-- --•-------.--- ----.-._..__...._.DATE <br /> DATE// .� 7_ T <br /> ADDITIONAL COMMENTS .........:..........••---_ - ' <br /> ---------------- __----- ' <br /> T <br /> -------- ------------------• -- . ----.----•-. <br /> Final ins a .. + <br /> p ctian b -•......................... ,// <br /> • ,. <br /> EH 13 2�. .r=6 <br /> ......... ....................•-.................:..Date ..A . <br /> •- <br /> -: .. SA.N JOAQUIN LOCAL HEALTH DISTRICT . <br /> . 8/74 3M <br />