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im 1. 1- IT " Id-eu <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT- - Permuit No <br /> "-_4a­r� <br /> _--tc0 mplete-in Triplicate)--— <br /> ----- ---- ---------:------- Date Issued,_%Z6_--.6-7 <br /> or —This Permit Expires I Year From Date Issued <br /> --- ------------ ------------- ----------- - '% <br /> I _j , � -% , i k <br /> Application is hereby made to the San,Jbaquin Local Health District for a permit to construct and install the work herein <br /> descr=ibed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB,ADDRESS/LOCATION -----------------------------------------CENSUS TRACT ---------------- --------- <br /> t Phone --------------------------Owner's Name --- �3,_Aj,lf------ <br /> Addres;------. —-------------- _V----------------- City ---- —---------------- ----- ---------------------------- --- <br /> 'Phone ------------------_ --------- <br /> Contractor's Name ------------------------I------------��L License #/ <br /> Installation will serve. Residence P�artment House,E] Com,mercial :E]Trailer Court E] <br /> Motel El Other ---------------------------- --------------- <br /> Number of living units-1------ Number 0 bedrooms 2-----Garbage Grinder _ZIV2� Lot Size -------- <br /> Water Supply:;Public System and ------------------------------ -------- <br /> name I --- ------------- Private <br /> ❑ <br /> Character of soil to a depth of 3 feet: Sandi'[] .4,Silt[I Clay E] Peatp Sandy Loam E] Clay Loam <br /> A to a <br /> Hardpan E! be Fill M t6rial ---------- If yes,type -------------------- <br /> pie i <br /> (Plot 1pl3n, showing size of lot, location of system in relatTicin tit6 wells,-buildings, etc. must be placed on reverse side.[ <br /> NEW INSTALLATION: <br /> (No septic t'a�nk-or-seepage-pi.t-per=*Ltted-i-4u.blic sewer is available within'260 feet,) <br /> i /N Size-------------------------------------=---------- :-.-- Liquid Delith ---------------- O <br /> TREAtMENT SEPTIC TANK 1 ents --------------------- <br /> 1—------------- Material---------------------- No. ComparHn <br /> capacity ----- Type <br /> Distanee.,,to nearest. Well -----------------I------------Foundation ---------------------- Prop. Line ----------------------- <br /> LEACHING LINE [J, No. of Lines ----------------- --Zength of each line-__-___-------------------- Total Leqgth ____-"_________________•-•-- <br /> 'D' Box Type Filter Material --------------------Depth Filter Material ------ ------------------------------ <br /> ----------- <br /> ------..,--Property Line ------------------------ <br /> -- <br /> SEEPAGE PIT --i_.,,� <br /> Depth -------------- Diameter ----------------Number ------------------- <br /> ------ --- Rock Filled Yes C] No Cl <br /> Water Table Depth ----i-.--------Rock Size -------------------------------- <br /> Distanc -Foundation --------------- ---- Prop. Line --------------------- <br /> e to nearest.' Well ------------- . ........ <br /> I ---------------P <br /> REPAR/ADDITION(Prev. Sanitation Permit� -----------------------------------j------- Date ---------------------------------- <br /> Septic Tank {Specify -------------- - ------------ ---------------1-- --------------i-----------I-------- ------------------- <br /> �1' -------�5- <br /> Dis .osal Field (Specify,Requirements) --- -- -- <br /> --------- <br /> ---- ----- ------------ <br /> -- ----------- ------------- <br /> ---- --------------------------------- ---------------------------------------------------------------------------------------------------------------------- <br /> Aa� (Draw existing and required addition on reverse side) <br /> ,Hy <br /> I he by certify that I have prepared this application and that the work will be done-in accordance with Son Joaquinn <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> s" agents signature certifies the following- <br /> certify that in the performance qf.the.,work for which this permit is ss ed I shall nos employ any person in such manner <br /> as to become subje o Wor ,s om ensation laws ofCalifornia." <br /> Owner <br /> Ci n e ---------- <br /> y Title ---------------------- <br /> (If o r than owner) <br /> FOR DEPAitTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- --------- --- ---------------------------------------------------------------------------------- DATE -------- -------- <br /> BUILDINGPERMIT ISSUED.---------- -- --------- -------- ----- ------------------------------------------DATE ----------------------------------- -------- <br /> ADDITIONAL COMMENTS --------- n_X4�-- ----------------e� - <br /> --------------------------------- --------------------------------------------------------------I-------- <br /> ------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I --------------7-------- -----------------------------------------I------ --------------------------------------------I----------------------I-------------- <br /> ------------------------------ <br /> ------------------------------------------------------------------------ <br /> ------ ------------------0 --------------------------------------- a ,. <br /> . .49 -------------Date <br /> Final Inspection byz --------------L-f---------------------------------------------------------------------------------------- ------------- <br /> _QA -HEALTH_kLTH_E alTRICT,_ <br /> E. H. 9 1-'68 Rev. 5M <br />