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9 .0 <br /> I. <br /> FOR OFFICE USE: <br />} APPLICATION FOR SANITATION PERMIT <br /> I ---- ------ ---- - Permit No: <br /> ----------- <br /> R ----- -------- --- <br /> _..._ _--- --.-,----.— y-(Conrptete-in Triplicate) <br /> This Permit Expires 1 Year From bate Issued <br /> Date Issued <br /> _ <br /> -------------------- --- ----------------------_-- <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 /> JOB I AD 14701 E.—C-O --er <br /> DRESS/LOCATION --------------- ---------------- t3 ------ --------- <br /> -------------- <br /> t`ENSUS`TRACf -------- <br /> JOB ----- - <br /> 7 <br /> �- 7 3S Phone ----46-2sl-OJ 2= .... <br /> .Owner's Name ----Mr.z Lqtark--- -----------------------=--------- t - <br /> Addr'ess -----SaMe_ -------------------------------- ----------------------- "= \ 7 `,City - -------------------- ------------------- ......... <br /> f yy--�� <br /> ^ f <br /> r Contractor's NameBlLaka-r—d- -�-- ' ` License ...ba951--------- Phone b�_= 4 __._. <br /> Installation will serve Residence M Apartment House❑ Commercial :❑Trailer Court i❑ <br /> Motel ❑Other _-M0b1_1_,-Hotae--------------- <br /> Numsber of livingunits:_._ __,_-. 1Number of bedrooms ---__ Garba a Grinder _____.--__._ Lot Size .___2__ Y'e�_____________________ <br /> 1 2 9 r <br /> F � ) -- .am ------- -----Private <br /> Water Supply: Public System and name Y <br /> Character of soil to a depth of,3 feet. Sand' Silt ClayPeat Sand Lo ❑ Clay Loam '[:] # <br /> ---------- <br /> ` Hardpan ❑ Adabe Fill Material ------___--- if Yes, -_;- V.--- ----- <br /> i � <br /> t r 1 + <br /> (Plot].plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse 'side.) <br /> s <br /> I NEW INSTALLATION: (No septic to k or seepage pit permitted.if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK •Side_____-4-�;x- -'-x1Q n---------- q P <br /> -------- <br /> �] i � k_____�l:i ui � Depth v <br /> Capacity 1244 TYPe � '- 'Yt Material �oYiCTetlBo. Compartments <br /> Q <br /> L- =q-Ya { <br /> Distance to nearest: Well -- - 200_---------;------Foundation _1_Q-- f Pip 1_0L0-°--- ------ �' <br /> 1 y � <br /> LEACHING LINE ] No, of Lines 1__-___--_ ______ 1Lendf of each dine----1,0a+---------- --- Total Length ,__- -------- <br /> u' ` 1 <br /> i 'D' Box ------------ Type Filter Material __-___--� �-------Depth Filter Material` ----------- 9_�©�1---- _ 1-------. <br /> u <br /> 4 Distance to nearest: Well ----- _____-ZQ_0 t___--Foundation ._24- -------- ___: Pro er Lin '_.._--_. <br /> ' Depth 2. ' Diamete'r ___ 6.'______ Number _. _�_ Rock Filled Yes ® No i❑ <br /> SEEPAGE PIT PC] p 3r ------------ it 1-------------- " ' i <br /> j Water Table Depth 90 -._��:Rock Size -2-------------------- <br /> ' j i t <br /> Distance to nearest: Well ------f__1-5da-------------'------Founda�tion�- 1-Q4!------- Prop. Line ------1.002.j.----• <br /> /� <br /> REPAIR/ADDITION(Prev.` � <br /> Sanitation Permit# --------------`:--------------------------I _ Dater---------------------------------- <br /> Se• tic Tank (Specify Re:uirements) .......1240 gg1• �"` !� --------------------- ,-------- <br /> Disposal Field (Specify Requirements) 1QQ� Le&Gh__171ne---&,25 .X-3-6-----P_it-------------------------------------- --------------- <br /> i `r., P <br /> ----------------------------------------------- <br /> 1 + <br /> ------------------•'—________-__-----_--------I-------------------------------------------------------------------------------------------------------------------------------------- ------ <br /> _ _______----..._____________________-_______—________----________________--____-______________-_____________._______.___--_-.___?._____ <br /> (Draw existing and required addition on reverse side)I <br /> ! <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> % <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. <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 /> r <br /> as to:become subject to Workman's Compensation laws of California." <br /> Signed --------------------- ----------------- --- Owner <br /> l Title <br /> --- - ---- - <br /> (If other than owner) s <br /> FOR DEP RTMENT USE ONLY y <br /> I -------------------------------------------------------- DATE _ - -/---- <br /> APPLICATION ACCEPTED BY _--t ----------- . -.__ <br /> BUILDING PERMIT ISSUED - �' DATE <br /> ADDITIONALCOMMENTS ------------ -- ----------------------------------------------•-----------=------------- ---------------------------------------- -------------------';------- <br /> ` _C. -------------- -----------------------';-------- <br /> --------- --- ------ ------------------------------------------------------------------------------ -------------- -- -------------------- <br /> t - ----. <br /> --------- - r - <br /> ' - ----------- `' J ------------------- ------- <br /> ------------------------------ - - <br /> Final',Inspection b Date T- -- <br /> _ � SAN JOAQUI LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />