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rVK UPPICE USE: <br /> __­?.•_'__,-.--------- ................... ........— APPLICATION FOR SANITATION PERMIT <br /> .................r............................ fcomplete in Triplicate) Permit No_f_.... <br /> -------­--------­ .................................... atIssued ......... <br /> This Permit Expires I Year From Dote Issued De - ------- <br /> Application is hereby made to the Son 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 /> lJ�D /111 <br /> JOB ADDR'SS/LOCATION ......R1,0.............._............-.CENSUS TRACT ......................... <br /> Owner's Name ....CIA ..........................................*...................Phone ........................ <br /> Address <br /> ........ .............-.......-.......... ................. City ............ <br /> Contractor's Nome --------1-4 4&_ —------------ .............. .........License # Phone <br /> Installation will serve- -Reside-ncel4Apartment Houseo Commercial oTraller Court 0 <br /> Motel 0 Other <br /> Numberof living units.1--- Number of bedrooms Q......Garbage Grinder ..........._ Lot Size r;2%.................................. .. <br /> Water Supply. Public System and name ....... ---­_­................................I................................ ......................Private <br /> Character of soil to a depth of 3 feet. Sand E] siltE] jo <br /> Cloy 0 Peat 0 Sandy Loam,10 Clay Loom 0 <br /> Hardpanf] Adobe 0 Fill Material ............ If yes,type...... <br /> ......... ............ <br /> iPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.)' <br /> NEW INSTALLATION: __ (No_septic:tank or,seepage,pit <br /> -permitted If public sewer is available within 200.,feet') <br /> PACKAGE TREATMENT SEPTIC TANK I ] S iA - <br /> 'z a.. ......... Liquid Depth ..... .. <br /> Capacity ... Type rAre_eb45&oterIal...............ti...._ No. Compartryients ...a............ <br /> Distahcetitd nearest; Well op <br /> -,3�_ ,I....................Founclotior��Vo........ Prop: Line ..... <br /> LEACHING LINE No. o!lf Lin7e.s'_'� <br /> -- ----- . ..... <br /> Length of each fine...- Total Length ... Or2e 7............. <br /> Type Filter Material a Depth Filter Material <br /> V Box <br /> ...................................... <br /> cl <br /> Distance to nearest: Well �61 157 ----------- ... Foundation ••- rProperty line 5l ......... <br /> SEEPAGE PITDepth ................ ... Diameter --------- ------ Number <br /> Water Table Depth ---------- ... <br /> ... • .............14) Rock Filled., Yes C] No <br /> ........... ............. ----..Rock Size .... .... .. ....... <br /> �Diitance to nearest: Well .......... <br /> . ... <br /> REPAIR/ADDITION lPrev_;'S.dn itation,Permit# ........ ........... ....I------------ Date .......... ...... <br /> .. ....................Foundation .. . ............. Prop. Line —........... <br /> ...... <br /> Septic Tank (Specify-Req,uire-ments) .................... -------- ................. I <br /> .................. ......................................................... <br /> Disposal Field (Specify-Requirements) ....... ....... --------- <br /> .-:-------------- --------------------- ----------- 7------- <br /> 46 <br /> ...........-----�k_,_,:- - V� <br /> ----- -- -------- ................. .............................. <br /> ......................... <br /> ----------------------- ---------- <br /> ---------------------­ <br /> ---­---------­-- <br /> Draw existing and requir'ed ;ddiiion--o-n"reverse-side).............. .......... ............. <br /> I hereby certify that I hoii-pi4ored this application and jh of the work will be done In accordance with San Joaquin <br /> County Ordinances, State jaws�_ <br /> 8 and Rules and Regulations Of the San Joaquin Local Health:District. Rome owner or licen- <br /> sed agents signature cerfifie' s'thi following: <br /> "I tertify that in the"erforrn"ie of ermit"Is, l <br /> issued, I shall not em any person In such manner <br /> as to becameth� work for which this <br /> s?blecta rk YCom nsati n laws of California." p <br /> Signed .......... <br /> ---------------- Owilb­ A <br /> By ....­-------I--------------------------------- ---------- ----------- ........... ..... 1-jitle <br /> ............. ......... ......... <br /> ----(If other-than owner) . ..... 4_7 <br /> Vk FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> - ---------------------------------------------------­­7---------.-------.--.-.---.--.--.--.--.------------ -7-- ...... DAT <br /> E -__-&-----�--�-4-----.-7--1-57-- --..--... .........BUILDING PERMIT 'ISSUED -------- - *- -- . <br /> .ADDITIONAL COMMENTS ------------- ------- ­ --- ------------ DATE .. <br /> ---------- ................... -------------------I.................... ........ <br /> --------------- --------I------------- ----- ............... ---------------I---------------------- .............. ............... ...................................I i <br /> ........... ........... - ------- . ..... ------- <br /> --------------------------------- ..................... ........*........*----------------------------------- <br /> -----------------*----------------------------------------*........... ..... <br /> not Inspection by: ---------- ....... <br /> -----------------­---------- .................. -----------6 i <br /> EH 13 2h 1-68 5K SAN JOAQUIN LOCAL HEALTH DISTRICT--- --------- ate ........... .........1_-------- <br /> ------------------------- ---- <br /> Fi . . ..... <br /> ........ .. <br /> 8/7h 3M <br />