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FOR dFFICE USE: APPLICATION FOR SANITATION PERMIT. o <br /> ---------- Permit No. (/1- 7` <br /> '�`�'"""'-`�-`- ':=•�w �` �(Co p ete in Triplicate) <br /> - Issued Dote Issued <br /> ------------ ��� d------- i <br /> +` �_ '..._ This_Perg! t.l xpires 1 Year From Date <br /> A pLation is her9t5ade to the San Joaquin Local HealtK District for a permit to construct and install the work herein <br /> described. Thisapplication is made in compCiance with County Ordinance No. 549 and existing Rules and Regulations: <br /> J08 ADDRESS/LOCATION -------- - ----------KRINSUS TRACT --------------------------- <br /> ------------ <br /> --- --------------------- ; <br /> ii f <br /> Owns is Name 5g J.QV4 S_6----------------- ---- Phone <br /> T " /t11G-_S City V¢tJR1�1� <br /> Ad.'dressr: -`iPf T� Z.,1 F9 <br /> 11� <br /> y } i Are �1 � A Phone - <br /> Contractor s Name -- A-- _ _ _ --- - - - - --Sp- _�--- --Lacense # ------------------- 1 <br /> Instdllataon I serve: Residence partment House❑ Commercial ,[]Trailer Court ,❑ <br /> i + Mp tel-2 Other IN <br /> O �� X 00� <br /> Nu,rnber of living units:'�_�___ `Number of" d.rooms __2 _._Garbage Grinder -N________ Lot SizeJPQ--- + <br /> Wr Supply: Public System and name �F� N�t _yJ- r��--- ----- Private ❑ <br /> Ch r cter of soil tord depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,D <br /> rdpan ❑ A obe� Fill Material ------------ If yes,type _-_------------------------ <br /> (At plan, showing size of lot, location o MysterR it -relation to wells, buildings, .etc. must be placed on reverse side.) <br /> NE,. jINSTALLATION: (No septic to k or seepage pt permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATME 'T [ ] SEPTIC ANK'I ] ize---------------------------------------- - Liquid Depth ------------------ -------- 6�k <br /> Capacity Type i ---- Matericsl---------------------- No. Compartments ------ ----------= <br /> ----Foundation ---- ----------------- Pro Line ---------- <br /> Distance to nearest: Well __________�_______________ __ p• <br /> N- ` ' pr <br /> LEACHING LINEA No, of Li es _______I__________ _____ LengtFa of each line___­4n Total Length --- <br /> Y�.� <br /> r� <br /> D ox -- Type Filter Material --------Depth Filter Material --18_-___------------------------------ 1 <br /> YIl► --� Foundation -- - ---- - - - Property <br /> Distance io dearest: Well _-_______-°___ A --_. Pro er Line, <br /> V <br /> SEEPAGE PIT Depth --.2 ---.------ Diaameter --, <br /> Number ._.____�_-_.__I-t`-��---- willed Yes No ❑ <br /> Water Table Depth -----7 --------Rock Size ----�-- -------- <br /> Ab <br /> Distance to ne❑rest: Well -----------------------FoundationQU Prop. Line -S.. <br /> REPAIR/ADDITION(Prey. Sanitation Permit# -------.------------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) ----------------- ------------------------------------------------- ----------- ---------------------_----------------------------- <br /> Disposal Field (Specify Requirements) --- flt` __ lit--D-----------t-------- ---��Y--1�->�---- <br /> ----------------------------. --=~------ <br /> -------------------------------- ---------------- -------------------------------------------=----------------- ---------------------------------------------------------- ------ <br /> (Draw existing and required addition on reverse side) { <br /> I hereby certify that I have prepared this application and that the work will be done in accordance 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: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br />' Owner <br /> Sig e <br /> -------------------- <br /> B i of ESTlli-�A-TB�1 <br /> -------------------------- <br /> Title - j <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY --------- ---------------------------------------------------------------------------------- DATE __ --- .--1 ------ ----------.•.------ <br /> BUILDING PERMIT ISSUED ------- - DATE ------------------------------------ ------ <br /> ADDITIONAL COMMENTS -� ._«- -- -- -------- -- ------- -------------------------------------------------- <br /> 4 --------------- --------------------- --------- ------ -------------------------------------------------------------------------------- --------- <br /> •---- <br /> ` ------------ ------------------- ,.pp ---- = <br />�t Final Inspection by l--- ---- ---- - ----- -------- ------------ -- ----------------- ---------------------Date ----- f,16 � <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t <br /> ✓ i <br /> E. H. 9 1-'68 Rev. 5M. _ y <br />