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FOR OFFICE USE: <br /> I APPLICATIOff FOR-SANITATION PERMIT <br /> } --------------;- -------=------ _ <br /> (Complete in Triplicate) Permit No. <br /> ;�I--"` This Permit Expires i Year From Date Issued Date Issued �7_-.73 <br /> Application is hereby mal to the Son 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 /> Vs �! z j -27/c2 r�G� <br /> JOB ADDRESS/LOCATION . ---------CO_11!-`je-------- -- •---------- ----C NSUS TRACT ------= -------- <br /> Owner's Name ----1' - laT "/ "f/ L - <br /> Q e-�dN = ---- -------=--------T�- F�hone <br /> ' � 9 <br /> E Address . � � .�- --------------- t <br /> City - r{40iN- --.-. <br /> f <br /> 'I I Contractor's Name --------------------------------------- ------License # ---------.-------------- Phone ------------------- - <br /> ---- - - - - - -------------------- <br /> Installation will serve: I Residence Apartment House❑ Commercial ❑Trailer Court ;❑ <br /> I Motel ❑ Other <br /> Number of living units:-----'/_- Number of;bedrooms --%9-------Garbage Grinder <br /> _14- Lot Size <br /> Water Supply: Public system and narri'e ----- <br /> - = Private <br /> w----Character of-soil to a depthl'of 3 feet: ---Sand'❑- "'ilt(] Clay ❑` 'Peat El' Sandy Loam—E]— Clay Loam'❑ <br /> Hardpan [ .Adobe-❑ Fill Material ----------- If yes,type ---------------------- <br /> (Plot plan, showing size old 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 /> PACKAGE TREATMENT — ' <br /> [ ] SEPTIC C TANK [ ] Size = ------------ Liquid <br /> t Depth -------------------------- <br /> Capacity <br /> -------------•----------- <br /> Ca acit TYpe ----- --=-------� Materia)-a!1�V1 No.- Compartments ----------------------- <br /> D <br /> ------._--.- <br /> Dsanceto nearest: Well __--_„___________Foundation _.--.--/[�_______._ Prop. <br /> ----_ Lie ----- <br /> LEACHING LINE Nol <br /> I, <br /> of Lines ------ ------------- Length o each line.------V40--------------- Total Length <br /> Box_y� ---- Type Filter_,.Mat_erial--_Ff'� -----Depth -Filter-Material_------A?------ <br /> T,~- -- --------• - -- <br /> Distance.to,.nearest: Well.. ------------t---- -- Foundation ----ft5 ---- Property Line __- - ------- <br /> SEEPAGE PIT [ ] De I.th ---------------- Diameter ---------------- Number .------0-------------------- Rock Filled Yes No i❑ <br /> Water Table Depth --- -------------------Rock Size <br /> Distonce'to`nearest: Well -_�:_=1� ,�,�p _--- Prop. Line ----h.U._- <br /> -�----�--�-----•-•----..Foundation -- - ----- -- -----.. <br /> REPAIR/ADDITION(Prev. Sahitati0n Permit# -------------------------------------------- Date -------------------------- ) �] <br /> -•------ <br /> Septic Tank (Specify Requirements) _____________________ - <br /> _ - <br /> Disposal Field (Specify Requirements) ----------- -- <br /> ------------------------- <br /> -------------------- <br /> ------------------------------------- <br /> t <br /> ---------------------------------------------------------------------------------- <br /> =----------------------------------- <br /> (Draw existing and required addition:on reverse side) <br /> 1 hereby certify that-I have,'prepared this applicationiand•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 perforrn�nce of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become sub' ct to Workman's Compensation laws of California.'; } <br /> Signed - -. - . -X------�-l` <br /> --------------------------------------------------- <br /> ------------------------------- ----- ------------`Owner <br /> BY -------- -- 4�-�`------- -.i--- ------- ------------ ------------- ------------- -- Title ------ <br /> - -- _ <br /> (iI other than owner) <br /> Jill FOR .DEPARTMENT USE ONLY c <br /> APPLICATION ACCEPTED BY,--- ---- € _ <br /> DATE �.7._.- <br /> BUILDING PERMIT ISSUED -'i�'------------ --- -----------------T_-- - -DATE - <br /> ADDITIONAL COMMENTS --'I--------- ---- <br /> ------------- - - - <br /> ------------------------------- --- --- ------ ---- Y _ ------ ----------------------- <br /> -- --- --- - -- - - <br /> -------------------------------- <br /> ------------- ---- <br /> / _ if`---- ------ -^ - - ---- -------- '”` <br /> Final Inspection by: -__-_ --------------------- <br /> ------ --- ---.--:'-,4 ------------ -- --- -----------------------------------� Date --------------------- <br /> SAN JOAQUIN L AL HEALTH DISTRICT <br /> is <br /> 1 '68 Rev. 5M <br /> E. H. 9 I � <br /> .i i <br />