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FOR OFFICE USE: <br /> ...............Z� APPLICATION FOR SANITATION PERMIT <br /> .......................--..:...�_ (Complete in Triplicate) <br /> Permit No. 7. 1... <br /> ------- .........-.. This Permit Expires al Year From Date Issued Date Issued J� �:Z <br /> Application is hereby made to the San 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 /> c...:. <br /> JOB ADDRESS/LOCATION �f a- GE <br /> Owner's Name ..........67c <br /> �...f�f:_.... _ : '� � .. �.... N5fl5..TRACT .:.:......._...:.......... <br /> ......................................:.........e...._._.....Phone ... ..6.�._.7�t <br /> Address .................... Ci#y <br /> _........... .r................. ......... <br /> y� t.............. 6rII� 1_ ..._....._.................. <br /> Contractor's Name ........:IC.c Q� ._PQ'J► p � . ,----...License # Phone <br /> ..--....._ <br /> Installation will serve: Residence 2�Apartment House 0 Commercial-[]Trailer Court 0 � <br /> Motel ❑Other ............... <br /> Number of living units:....0...... Number of bedrooms _.1 .-.Garbage Grinder .__. ....... Lot Size ..... ......... <br /> Water Supply: Public System and name ........:...... .. ..:•-;-_ •_ • I I <br /> _....._...._--•--------•=- .-•-. . <br /> Private <br /> Character of soil to a depth of 3 feet: Sand Siit Clay❑ [] y ❑ Peat[] Sandy Loam fl Clay Loam <br /> C Hardpan ❑ Adobe ❑ 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.) W <br /> I' NEW INSTALLATION: <br /> (No septic tank or seepage pit permitted if public sewer is available within 200 "v A <br /> feet,) <br /> I PACKAGE TREATMENT <br /> E 3 SEPTIC TANK i ] EA147INq Size.................... .. Liquid Depth <br /> ..._..... Type,,..•-••.............. <br /> Capacity ._......:.. Material...................... No. Compartments <br /> Distance to nearest: Well-.................................Foundation ...................... Prop. Line <br /> LEACHING LINE No. of Lines ..... ...............-_- Length of each line:_.:__-. '" <br />� — 9 �.._._:...... 'total Length �. <br /> t D' Box _.... _.... Type Filter M to I � J�...Depth Filter Material ...._L .� <br /> i <br /> ... ........�.. . <br /> Distance to nearest: Well ,..._... Foundation __. . Property Line <br /> s <br /> G SEEPAGE PIT Depth s .�..... Diameter �3.. Number,�.��`-./`_.......:. --- Rock Filled Yes No ❑ <br /> ...... ... . . <br /> Water Table Depth _ r Rock Size <br /> Distance to nearest: Well .... .�---- <br /> .� Foundation / -�-- Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date <br /> Septic Tank (Specify Requirements) ...................... <br /> ---•.•-------------•-....... ...._...__.._........,............ <br /> Disposal Field (Specify Requirements) .................. ­4�_:._ <br /> ------; ;--------•••-------•--•--••-----• ................ .........•--- ------•------•---._...... <br /> -----••••------------------- <br /> ...............I........................................................ <br /> row existing and required addition on reverse side) .............. ........................ <br /> I hereby certify that I have prepared this application and that the work will be clone 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 /> Signed . �: � : LS_ ... -Ss n ,_. .1� A._.._.:..._.. Owner 1 <br /> ..... <br /> By ......................... ....., Title _. - <br /> .._. ..... ._..... <br /> .... <br /> (If er than ownerl <br /> MR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..--. <br /> BUILDING PERMIT ISSUED ............ .................... DATE .... <br /> .. ........ <br /> -• ---••------••.--• ............................ <br /> - .. .........=-----....% -:..:DATE .. .-•- <br /> ADDITIONAL COMMENTS . r (1 _,¢ <br /> ::: .::::::::::::::::::::::::::::::: :::: - :::::: ... ...-:-- . =��.... ..... :::::....:::: <br /> -•-- <br /> Final Inspection by: ! ........ <br /> -------......... <br /> •.............. <br /> = •...I.............:.-tits . --.... <br /> D . .:... .............. f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 1-3 24 1-'68 Rev. 5M - <br /> 71„ z ,. A <br />