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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .rPermit No. - 3------------------ ------------------------------------- <br /> �.:- *j_ _-­ I (Complete in Triplicate) - <br /> i ,. .. Date Issued <br /> This Permit Expires 1 Year From Dale Issued <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 ADDRESS/LOCATION ..� -?-.:7,..._ '_I �- -------- --------------CENSUS TRACT ----------------- <br /> Owner's Name ------------------------------------ --------Phone --R_�aA: -�-7_� <br /> -----�---------- -- ----- - -- --------------------------------- ---------------- <br /> Address t ------ -----------. City ------------------•---------- --•---{ <br /> - ------ ------------------------------------------------ - -- <br /> --- License # - _,�- ''1 Phone <br /> Contractor's Name -_ _ .._ _.. _ � F <br /> Installation will serve: r.. ... esidence ZApartment House❑ Commercial' Trailer Court ',❑ <br /> Motel ❑Other -----------------y------------------------- <br /> �l0�r�t r""3 <br /> Number of living units:.__'..-._- Number of bedrooms ___-V-----Garbage Grinder `______.___ Lot Size _..-- <br /> El <br /> Water Supply: Public System and name:t_ '----- ----------------- ----------------------------------------- Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Sift❑. Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam p� <br /> Hardpan ❑ Adobe ❑ Fill Material ------ ----- If yes,type -_------------------------- <br /> (PlotFplan, showing size of lot, location 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,) <br /> SEPTIC.TANK:J-lam'Size----_---�-------------------' Liquid Depth ------------ <br /> Capacity <br /> ---------— <br /> PACKAGE TREATMENT..(_]....., �p/_ 3 --------------- <br /> '-l�aa Capacity -Yo.-�'------ Type - _a -- Materi'al---(�'- `' No. Compartments fY <br /> Distance to nearest: Well _- _10.61-------------------Foundation __./_�___-------- Prop. Line ------�_--------- <br /> ► s ' <br /> LEACHING LINE [ I No.-of bines ---------.----------------- Length of each line__--------------t-------- Total Length ----------------- <br /> w Y p 'D' Box _ - Type f=ilter Material l-1 -•-----DeptH\Filter Material ----- /_Y-------,--- -- <br /> - — _ � 4 -�:"Pr`operty-bne --_--------- ---•-- <br /> S.Arr a. Distance to nearest: 1Ne!}=- _`P_t7 _ Foundation -n <br /> SEEPAGE PIT [ ] Depth _ �`T --- Diameter -3/3�-_�""_ Number ------------ Rock Filled Yes No ❑ <br /> P_,e Water Table Depth -------- 4------------r-- �"'-- Rack Size �+-�� <br /> �� �O -----------Foundation"""1""�` �------- Prop. Line ----- ------ <br /> ��R <br /> � �•�' Distance to nearest: Well __.--t.�__. _____._ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _.._--__.------------------- Date ------------ --.r 3-__--_-_- <br /> Septic Tank (Specify Requirements) -------------------- --------------------- , ------------- ------------- <br /> -----------------------------------r--�F-- ----- - <br /> Disposal Field (Specify Requirements) --------------•-- - ----------- ------------•--------------- <br /> -------------------------- <br /> ---------------------------------- <br /> ------------------------------------ <br /> r <br />€ ____ ---------------------'---•-- - ----- <br /> ------------------- <br /> '- �. ' <br /> (Draw existing and required addition on reverse side) ) <br /> I hereby certify that I have prepared this application and that the work will be done 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 /> F as to become subject to Workman's Compensation laws of California." i <br /> Signed ------------------------ ------------- Owner------------------------------- f <br /> Title =` = E <br /> ------------------ --- <br /> By [lf -------------- <br /> other than owner t 1 <br /> FOR DEPARTMENT USE ONLY ) ) <br /> ---_. <br /> APPLICATION ACCEPTED BY -. ,----- - ---- - ----- -------------------------------------------------- <br /> DATE --- I� ------- <br /> BUILDING PERMIT ISSUED ----- ------------ ------------ ------- -----;DATE -------- ------------------------`-------- <br /> - ��--------------------- <br /> ADDITIONAL C MMENT 1 _ i i ' f - <br /> ' -- -- �--,� -, , <br /> --------------------------------- <br /> _..... . ` <br /> ------=------------------------ ------------------------------------------------------------------ : ---- <br /> `------------ ==' <br /> -------------- ---------------- ------------- •� � � ---------.Date�----/l -- 7-3---- -'•- -- - <br /> Final Inspection by: ---------------------------------------------------- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />