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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> - -------------- Permit No. <br /> (Complete in Triplicate) <br /> Date Issued _.__ <br /> ----------------- --- --- _- _---------___ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County.Ordinance No. 549 and existing Rules an Regulations: <br /> JOB ADDRESSAOCATION -----4691_Wa_s-t---Gana)--B1vd....... racy,...Ca,:-- -- ---- --CENSUS TRACT -'-- ---------------- <br /> Owner's Name ---jjS' ------------------ -------------------Phone _.415-=,536_---4-35A- <br /> -- <br /> ..... Y <br /> Address -------------------------------- <br /> Contractor's <br /> k <br /> -- , ---------------------------------------------------- --- city QaklaxS3,--- Ca--------- -- -- ------" <br /> ---y�-•------------ <br /> Contractor's "V-98'­ <br /> V <br /> -- • <br /> Name --_ "_P_ay-Les"__=_-5-eptia__�'ank__Servloe-------License # _2.61.-- ----- Phone4.6Z " 98-.:°------ <br /> Installation will serve: .Res€dence,M Apartment House❑ Commercial-:❑Trailer Court ',❑ i <br /> Motel ❑ Other - "------------------------= = €. <br /> Number of living units:...)------ Number of bedrooms ----Garbage Grinder-__110_11_ Lot Size _. ---aC.rea ____________________ <br /> Water Supply: Public System and name _____ _ al_g't_Q Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'D Silt❑ Clay ❑ +Peat❑ Sand L am -❑ Clay Loam [21 <br /> Hardpan E] Adobe ❑ Fill Material _.__--'_---r.If yes, type �-_r_____ - <br /> Ilk <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,.) <br /> i i �0 <br /> [ ] Liquid <br /> a ` <br /> PACKAGE TREATMENT SEPTIC TANK f ] P . Size_ 1_X_5!_X�� ----- L'quid Depth '--4i!`________________ <br /> r Capacity 1 2-00------ •Type _oblong--- Material-:-cement---- No. Cor>a€paftments -.--_. <br /> •; 1 . � i t <br /> D€stc°nce 3to nearest: =Well ---:_22C3---67el.1._______..- _Foundation ____20_t________� Prop. Line ._..�____"_��a�liz - <br /> f. ° <br /> LEACHING LINE [ ] No. of Lines ___.l� -. _'_____ Length of each line-'-.- -------------- Total Length ----- <br /> -�?f____--_.-__-__,_ <br /> - +yr • <br /> D' Box -_n0_I Type,Filter Moterialr_,_i2C�____----bepth Filter Material __tZ8t;__________________________________ _ <br /> _ _ ---# t <br /> ---Distance,-to,,nbarest: Weil,____riQ--well. Foundation_1flt7'_21U P7.Uu----- <br /> SEEPAGE PIT [ ] Depth -------------------- +Diameter ---------------- Number -------:-------------------- Rock Filled,Yes ❑ No <br /> p Water Table --- <br /> De th t ; <br /> p -'-------------------- -- Rock Size <br /> r ° ---------------------------•---- <br /> tl -----------•-------- 3 <br /> Distance to nearest: Well #________________------------------------Foundation -------------------- Prop. Line ----------- <br /> % <br /> ------------------------------------ Date ------------------------------ 1 <br /> REPAIRJADDITION(Prev. Sanitation Permit#°---_-__ � <br /> � t <br /> Septic Tank (Specify Requirements) __ _______________ _______ <br /> Disposal Field (Specify Requirements) ----=-------=------------------------------- --------------------------'t------f---- ----------•----------------- - - <br /> i i • <br /> ----------------------------------------------------` ----------------------------------------------- <br /> ----- N <br /> I ----------------'---.--------- -------,------------------ <br /> - - ----------- -------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side] <br /> 1 <br /> I hereby certify that I have prepared this application and that the work will be do'e in accordarieb 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: r l <br /> "I certify that in the performance of the work for which this permit is issued, I shall not empioy any person in such manner <br /> r <br /> as to become subject to Workman's ensation la of California." <br /> Signed --- ----- ---- ----- ' ----------- ------------ Owner <br /> BY ----------------------- Title _ ovmex----------------- ------------------------ <br /> er than o er T'r'y' . :�nTarthan <br /> ° <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----f------- ----- ----- �� ---------- �� YJ------- DATE ------ ---- - <br /> BUILDING PERMIT ISSUED --------�---------- ------------------ ------- ----- ---------------------------------DATE ------------------------ ---------• <br /> ADDITIONAL COMMENTS ------__________________{ ° <br /> ---------------------------------------------------------------------------------- <br /> ----------- ------------------------------------------------ ------ -------- -.------------------------------------------------------------------- ----------__--------- ------ ----------- <br /> - - <br /> ------------------------- ----------- ------- r---- -- ----- ------------------------------------------ -- ----------- <br /> ------------------------------ <br /> - <br /> Final Inspection by: ---- •-��.- ` Date --�_�x.- ._-- <br /> S JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68j Rev..5M <br />