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T <br /> FOR OFFICE USE: <br /> �'71E,. APPLICATION FOR SANITATION PERMIT Permit No.. 76-5-. <br /> OR 0 ICE US ------- <br /> -------------------------- --------I--------------------- (Complete in Triplicate) <br /> ,,,-Z I I Date issued - <br /> ---------------------------------------------------------- This Permit Expires 1 Year From Date issue <br /> ---- ------ ----- ------ ----- --------------- herein <br /> ------------------------------------------ construct and 'install the work <br /> made to the San Joaquin Local Health District for a permit to con <br /> and Rules and Regulations: <br /> Application is hereby location is made in compliance with lc2onty Ordinance No, 549 ona x, <br /> described. This app ' <br /> 1 <br /> ------- ---- <br /> X1 <br /> --- --CENSUS TRACT - <br /> JOB ADDRESS/LOV TI N ---------------------- -------- <br /> --- - - ------- ------- <br /> _J A --Phone <br /> Owner's Name -Z-Aol <br /> 2.-,Qa141,0n - —y— -------------- <br /> ap f City ------ _ 7 <br /> ss &�,I,--------Lic e <br /> Address ense Od--- Phone <br /> Contractor's Name <br /> -ial:E]Trailer Court �E] <br /> Residence Apartment House[I Commerc <br /> Installation will serve- <br /> - -------------- - ------ <br /> Motel [I other ------------ <br /> Number of living units' --Number of bed bedrooms t�-2a rbage rinder ------------ -Lot Size=-------------�-­ ------- <br /> - -------------------------- _Private <br /> ic. --- <br /> Water Supply-, name --- ---- <br /> Publ Sy;tem�an <br /> Silt Clay .0 Peat F1 Sandy LoomO Clay Loom 11 <br /> Character of soil to a depth of 3 feet- S6nd'E] <br /> Hardpan E] Adobe --------------- <br /> Fill Material ------------ 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 /> ,itted if public sewer is available within 200 feet,) <br /> (No septic tank or seepage pit perrr ------ <br /> NEW INSTALLATION: --el, D pth <br /> ­X Z--------- ---- Liquid e <br /> PACKAGE TREATMENT V SEPTIC TANK Size & �4 '. - ---------5;4, <br /> --------- 01 Pro <br /> Capacity/S 00 Type�6-&-4-f- M- aterial-A -0. ........ No..1 Compartments. <br /> lydtl,�V� IL- --Foundation--l-&-1------------- - p, Line <br /> Distance to nearest, Well / i <br /> 4,0------------------------ ------- Total Length ----------------------------- <br /> LEACHING LINE No. of Lines ------------------------ Length of each line----------------- --- T I .............. <br /> V -Depth Filter Material -----r- ---------------- <br /> - - <br /> Box ------------ Type Filter Material ------------------- ,I ' <br /> Foundation ------------------------ Property �Line. ------------------------ <br /> Distance to necirest-. Well ----------------------/--- Yes bg( No <br /> Rock Filled <br /> SEEPAGE PIT id <br /> -------- <br /> Depth ---- Diameter Number ----- <br /> -----------V- <br /> ------------- ---------------------Rock Size ro <br /> Water Table Depth Line <br /> -------------Fouhd.ation, ------ P" <br /> s <br /> Distance to nearest. Well <br /> Date -------------- --- -- --- <br /> -..,REPAIR/ADDITION(Prev- Sanitation Permit# ------•- ----- ---------------------------- <br /> ---------------- ---------------------------------------------- ----- <br /> Septic-.Tank (Specify Requirements) ---- ------------------------------- --- --------------- <br /> ----------------------------------------------- <br /> Disposal Fidl-d (Specify Requirements) -----------7------------------------------------------i ------- <br /> ----------/----------------------------------------- <br /> ------------------------------------------------------------------------- ------------- I <br /> ----- -------------------------------------------- N, --------------------------------------------- <br /> ----------------------------- - <br /> ----------------------------------------------------------- ------------------------- I <br /> ----------------- (Draw existing and required addition on reverse silcle).,,,�,,�.,,,- - I <br /> I I n Joa4vin <br /> nsto <br /> t th0ntI hereby certify that 11' have prepared this application Oalth District. Hoineowner or licen- <br /> and ltuie`sa6d,Regulatf the Son Joaquin Local He <br /> County Ordinances, State Laws <br /> sed agents signature certifies the fol[OV[ng-- p n in such manner <br /> "I certify that in the performance-cif the vVqj1tk for which this permit is issued, I shall nol'6niploy any arson <br /> as to become subject to Workman's Compensation laws of C liforma." . , 4,� 11, , <br /> wner <br /> - ----- - ----------- <br /> Sig 1 d -------- Title ------------------------- <br /> ----------------------- -------------------- <br /> L , aj!�V­ <br /> ByCU. (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ----------------I DATE ----- ------ <br /> ----- ---- -------------- <br /> APPLICATION ACCEPTED BY ----------- ----------------- -----------DATE ------- ----- --------- ----------------- <br /> - ------ - -----af­ <br /> BUILDINd PERMIT- ISSUED -------------- --- ------------ ----- ------- <br /> ---------------------- <br /> ADDITIO�Al­ COMMENTS ---- ------ ------- - -- <br /> -------- -------- -------- ---------- ------ <br /> ----------------- <br /> --------------- ---------------------------------------------------------------- ------------ --------- -- ------------ ------------ <br /> -------- ----- ---------- <br /> 67 7AT E <br /> APPLICATION A�rr PT�FD B�Y ---�- AT <br /> -------------------------------- -------------------------------------------------------------------------- --------- ------- -- ------ <br /> ----- <br /> ----- -- ------- -------------------- I I ------ -Date --------------------------- -------F, <br /> ---- --------- ------------------------ --------------------------- -------­­--------------- <br /> Final Inspection by. <br /> ;�ICT <br /> SAN JOAQUIN LOCAL HEALTH DIS <br /> /9. 1-'68 Rev. 5M. <br />