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FOR OFFICE USE,. <br /> ........... --------- APPLICATION FOR SANITATION PERMIT <br /> 5 <br /> (Complete in Triplicate) it No.�7i ............ <br /> ................................ Perm <br /> .........I——.........I...... Date Issued <br /> ...... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District foga permit to construct and install the work herein <br /> described. This application is made in compliance with County OFdI'no,n6`1N6.',549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..._-35%,o....6.... <br /> . ......... <br /> ............... ..CENSUS TRACT A4 <br /> Owner's Name <br /> lr� .moi __Co .: u:e ;i; ................ ......... <br /> ...... --- ------- 0 <br /> Ph .... <br /> Address <br /> . . .. .............. <br /> Contractor's Name <br /> .....................Lld6nse # <br /> Phone,.­. F.- <br /> Installation will serve: Residence 13-Apartment House 0 Commercial oTraller Court. <br /> Motel C]Other .............. <br /> Number of living units:--- ........ Number of be4ro'oms.......2--Gar-bage,.Grinder,---------_� Lot Size ....4-C.&O <br /> Water Supply. Public System and 'name ............... ................. <br /> --------- .................................. ..........Private P_ <br /> Character of soil to a depth of 3 feet. Sand 0 Silt 0 Clay [3 peat E] Sandy Loom 0 Clay Loom <br /> Hardpan Adobe E]-,Fill Material ------------ If-yes, <br /> Mot plan, showing size of lot, location Of.. system in relation to..welli,,buildings, etc. must -be.ploced on reverse side.) <br /> NEW INSTALLATION: (No septic lank oriseepage pit permitted if public 'sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK' 'Size ..........I........ ........ w........ Liquid 'Depth ..................... <br /> iS Capacity ,................... ype ------------------KiMaterial--------- ........ <br /> ..... No. Compartments ..................... <br /> Well !:__.-_. Foundation .................. <br /> Distance to nearest: ........ tio Prop. Line ............._...... <br /> LEACHING LINE - ... ns ....... ' 7(V <br /> r ' .Length of each ,line'--•------------------------ Total Geing"ih ........................ <br /> V Box ............ Type 'F!Iter'Materi:l Depd, Filter Material_.....: ..:_.. ... .. ....... <br /> .............................. <br /> Distance to nearest: Well .......L_L Foundation <br /> .... ..................... Property Line .......................... <br /> PIT Depth ___-------_---- Diameter - ----_---_-_-Number <br /> ....... ................... Rock Filled Yes 0 <br /> AG <br /> Woter_Table Depth.......... ....... ,Or <br /> . .................Rock <br /> Size ......... ............... <br /> F7r <br /> A Distance to nearest. Well ......... <br /> ....................Foundation ........ Prop.' O <br /> REPAIR/ADDI.ION,(Privo Son itati on'Permit ............... <br /> .... ....... Date ................................... <br /> Septic Tank'..(Spe,cify Requirements) ...... ......................... ...... <br /> - -- --------------------- - <br /> ---------------- ...... <br /> Disposal Field (Sp 4 ------------ <br /> .... ..... ... <br /> ecify le'quirements) ...../.0- . ... -.... . CL_ <br /> ...................... <br /> --------------C1--------4­ <br /> ............................................................... .............. .......... ............. <br /> ............ ........................ ............ <br /> -----------------•----•..•-••---::..-••---:..-•----•-••--- <br /> ---­-----..................4............... ......... ...... <br /> (Draw e-xisting and required addition on reverse side) . .............. ............... <br /> I hiCl'l ' '/� - <br /> I hereby certify that I have prepared i �application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State.Laws, and Rules Aorid'Re-qu lotions-*f 'the ton Joaquin Local H s <br /> 0 or ilcen- <br /> sed signature certifies the following,*. <br /> "I certify that in the performance of the work`for,which this permit is Issued <br /> )4. 'r , ed,.l shall not employ any person In such.manner <br /> as to become subject to Workman's Coin ,dhiisti6n lows of California." <br /> k-* - p <br /> Signed --- 71 \ <br /> ............... ............. -------- .... Owner <br /> By <br /> �/. - - -....................... <br /> --._........... ------ <br /> - -- ........ ..........Title <br /> k, <br /> FOR DEPARTMENT USE. ONLY <br /> V 1, <br /> APPLICATION ACCEPTED BY ........ - <br /> ....................... ... ......... 7-5 <br /> BUILDING PERMIT ISSUED ......... . ..... ........... ............... DATE ............. ..... .................. <br /> .............. ......................... ..............DATE ......... .......... <br /> ADDITIONAL COMMENTS ....... .. ........ I .............................. <br /> ........................................... ................ --------------- <br /> ------------ ------ .......1-4............... ......................... --------- <br /> -----------­---­ -------- ........ ....... <br /> ................................. ......................... . ........................ <br /> ------------------------- <br /> ....-..f_....-..,___... <br /> ............................. ................. .......... ................. <br /> ...­.�.................................. ..................................... ............ ........... <br /> • <br /> Final Inspection-by. ................. .Date ... <br /> SAN JOAQUIN AOCAL` HEALTH DISTRICT <br /> E. H.13 '24 1,'68 Rev. 5M 7 1•,., 2 %ff Q-4b- <br />