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FOR OFFICE USE: f r APPLICATION FOR SANITATION PERMIT <br /> . <br /> _.................... ............... .... <br /> Permit No. .�yV�- ._VY-7 <br /> • - - � . .� �,_,,...•-•-: 1Complete in Triplicate] _ <br /> "` -. t a:. . Date issued _57J -7. <br /> ....................................... L� <br /> This Permit Expires ] Year From Date Issued <br /> )Cal ealth is the <br /> Son <br /> Joaquin Lt <br /> complirince wiHh Cau District <br /> described. This application ytOrdinarice Nom544" and existing Rules erit to construct and tand Regulations:l the work rein <br /> Application is hereby mode �a� . <br /> CT <br /> ........................................ CENSUS TRA <br /> ........................ <br /> JOB ADDRESS/LOCATION .. 1 ... . ..phone <br /> Owner's Name _-._ . _ <br /> Address ..-----.....-•-.-••..................................................... city •-•....................... <br /> ....License # .........:.............. Phone ..... ........ <br /> Contractor's Name ---•jAh�-�."' .. ��•--•-----.....•------ -- <br /> idence Apartment House 1-1 Commercial ]Trailer Court 0Installation will serve: Res <br /> Motel ❑Other ............................................ <br /> Number of living units:.... Number of bedrooms _�....•.Garbage Grinder �,94�.___ Lot Size 49 ..- .. -•-••- •.... <br /> -, ❑................................. Private <br /> Water Supply: Public System and name 1-�l_. ��'17-- 1 � <br /> Character of soil to a depth of 3 feet: Sand❑ Silt ElClay ❑ Peat C1 Sandy Loam ❑ Clay Loam <br /> Hardpan C] Adobepg Fill ❑ <br />` y <br /> Materia! __......__.. If es,type ..._..---•------ ---•-----.. <br /> (Plot,,.plan,..showing,size _of-lot,..iocation..of..system In relation.-to.wells, buildings, etc...must be placed on reverse side.) � <br /> NEW INSTALLATION: {No septic tank or seepage ,pit permitted"�if public sewer-is available within 200 feet,] f <br /> ' WSiae���Xl Liquid Depth <br /> �-f r ................. <br /> i SEPTIC TANK e.............. .. � <br /> PACKAGE TREATMENT ( ] <br /> t <br /> - Material /.l -..-._. No. Compartments <br /> ................... <br /> I Capacity l�F ._ Type. ....._..... <br /> f <br /> Distance to nearest: Well - '`•...:__.•...;--- ..1� • Prop. L� <br /> p •ne <br /> No. of Lines - Length of each line._ ' -�... ......- `Notal Length .1 ... <br /> LEACHING LINE J ..... ..-__.. <br /> De th Filter Material/. ...__-•••-••-•4%............ <br /> 'D' Box i���._ Type Filter Material . -l�- - P ��r <br /> �' ` Foundation -./D.-.'.. property Line .. <br /> Distance-to nearest: Well.-......_........_ <br /> f �� Diameter ._�...._-__.. ..`Number ..... '........... ... Rock Filled Yes No <br /> SEEPAGE PITS'` [ ) Depth 1p-�'� r <br /> -- <br /> Water Table <br /> [ ...Rock Size Irk ---------••------ <br /> Depth.,..�p��....... ......•---•--..._...._ •' Pr lin - -------.._......... <br /> I Distance to nearest: We <br /> Foundation Ze?.......... Prop. .� <br /> �. - <br /> pate ................................. <br /> REPAIR/ADDITION{Prev. Sanitation Permit. <br /> ......_ ....... <br /> .............. <br /> Septic Tank (Specify Requiremen s ; �...-_-• ....... <br /> ----------------------------------- -------------------- <br /> Disposal f=ield {Specify Require <br /> men#s} .,- '' <br /> r� <br /> t <br /> --------- <br /> ....................................... <br /> ------- <br /> -------------------•-•--.-.---------------- _ ...... <br /> . ...._. <br /> ----•------------------- - <br /> .:s - (Draw existing and required addition on reverse side) . <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> I h <br /> ConOrdinances, State .Laws, and Rules and, <br /> Regulatitans-6f the-'SanJoaquin`Lacal Health District. Home owner or licea- <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 /> :....._... Title . _ . .................. <br /> . ....................... <br /> (If er than owner) ` <br /> FOR DEPARTMENT-USE ONLYev <br /> ",I .. <br /> E DATE .... :.- . <br /> APPLICATION ACCEPTED BY . _..... <br /> ....... _..-...----...---....................-•---• <br /> BUILDING PERMIT ISSUED ............................................ ........................... .................. ........DAT <br /> ADDITIONAL COMMENTS...... <br /> •. <br /> .. <br /> �•� ................. <br /> ..... ........ .......................... _ ... ~---•--..:...__..........._..._.....----...''Date <br /> ... `-{ -• <br /> Z <br /> • �' <br /> Inspection b fa -.......... <br /> l FinalInspec y tJ ` <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/723X <br /> 13 24 1_'AA Qp.._ 5M - -- <br />