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FOR OFFICE USE. J yr 7-2 <br /> PPLICATION FOR SANITATION PERMIT <br /> ----- -l4 T. Permit No. <br /> (Complete in Triplicate) - <br /> ------------- ---------------------- <br /> Date Issued <br /> -- <br /> ------------ -------- This Permit Erpires 14Year From Date Issued <br /> I <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 /> _ J_ s <br /> JOB ADDRESS/LOCATION .:.-- `]...... <br /> �1 V-it-S-I O CENSUS TRACT - <br /> Owner's Name <br /> ----- -f - --- _t_ <br /> = Phone -t�� �/-`�� <br /> c -+7 --------Df.V J- --0_t ------------------------- Cit -_11 l� f�_ `-------- n==-----=---------------------- <br /> Address ----------- I�-�: -- - - -- - Y .....-- <br /> Contractor s Name - n-je-Ps--------- - ----.------------- Phone ------------------------: <br /> Installation will serve: Residence partment House❑ Commerc al5e Traile <br /> r Court ;❑ <br /> .,,� <br /> Motel F-1 Other = ,s. <br /> Number of living units: __ `NumbEr of bedrooms __/--------Garb age Grinder _ -------A10-; Lot Size -_ 4 =��' � --••j -- <br /> �M ` Private <br /> . --'Water Supply: Public System and name-------- =--- ---------------------- -----;-----------------------------•---•----------------------•-------- ❑ - <br /> Character of soil to a depth!of 3 feet: Sand'; Silt❑ Clay © Peat❑ Sandy Loam ❑ Clay-Loam ;[ <br /> �i Hardpan ❑ Adobe '❑ Fill!Material - - <br /> (Plot plan, showing size of lot, location'os system, in relation to- wells, buildings, etc. must be placed on' reverse side.} r <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted il;`i�ijac se{we s��va�lable within 200 feet,] <br /> r �1,_ f� <br /> PACKAGE TREATMENT { ]I� SEPTIC TANK fil Size- =�sr-.--_-_- -__._------ -------------- -Liquid Depth ---___----.----- <br /> Capacity Type �eA�'Material- ------ l - No, Compartments <br /> / ? <br /> Distance to nearest: Well ---___� _��- ---------------------Foundation _ -_--7. p. Line _-__- - <br /> LEACHING LINE [ ] N . of .Lines ------ <br /> ---------Total <br /> f Lengt QLength!...r- <br /> -- - ----------- <br /> 1/0 <br /> ---------- <br /> �� _T a Filter Material_; -C _-Depth Filter: Materialf <br /> 'D' Box ) <br /> , Y <br /> I <br /> �-Distance to nearest: Well .-- ---__-.4-- Foundation _.1 Q___:" -._' Property Line... .--.-------------- <br /> p tY <br /> SEEPAGE PIT [.] DeMpth -------------------- Diameter -.__ Number .--_-.-______-_F- --_ Rock Filled Yes ❑ No <br /> t <br /> Wter Table Depth --------------J------- -----_--------_-Rock.Size --------------------- ---------- <br /> : I <br /> Distance to nearest: Well ------'---------------------------------Foundation------------ -frr- Prop. Line ----------------- --• <br /> REPAIR/ADDITION{Prev. Sanitation Permit# --------_-----�- .-------------------- ----- <br /> Date _- M } t <br /> p p Y �q� .ig V Yl�i 1 - <br /> ------------------- <br /> Se tic Tank {S ecif --Re uJr..em4ents) - --: � ' .- € t <br /> ^ -- 5�. 1_..-. -��---- -�-�?`�` - ------4r' <br /> Disposal Field (Specify; Requirements} -y -- __ --- -----�AS--- <br /> ---------------------------------------- <br /> ---------- <br /> ------------- <br /> - �----------------------------- ------- --- ! `5_ __---------------------------- '----------------------- <br /> _---- -- ill.7t-Ic�c � <br /> 0 <br /> {Draw existing and required addition on reverse side) <br /> I hereby certify that I ha�'e prepared this application and that the work will be done in accordance with San Joaquin ` <br /> Y <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: j T <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 /> h <br /> i Signed .ate �- _�!�^Z - Owner <br /> _ -- ---- <br /> ----------- <br /> - Own <br /> ----- ---------/ --rL, ----------------------------- Title <br /> (if other than owner) <br /> -1-FOR DEPARTMENT USE-ONLY <br /> APPLICATION ACCEPTED �BY . =F 1----------------------- DATE -I_"- -.1--_`; .c' <br /> BUILDING-PERMIT-ISSUEDk ;�� <br /> ADDITIONAL COMMENTS��._- _-- -� <br /> - - -"= - -----------JLC -------------- ------------------------------------=- ---- <br /> -------- <br /> - = - --------------------------------------------------- ----- = <br /> �1------ ---------------•--------------------------------------------------------------- -- ---------------.Date ---------=_-------------------- •� <br /> Final Inspection by: ___-:----- <br /> SAN JOAQUIN LOCAL H(<ALTH`11STRICT <br /> E. H-9 <br /> 1-'68 Rev. 5M' <br /> A <br />