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-� it <br /> OFIcE uses <br /> APPLICATION FOR SANITATION PERMIT <br /> .-� Permit No. .7 <br /> .............. ..... (Complete in Triplicate) <br /> .... ....••. .. <br /> _ ? <br /> Date issued..'f .. <br /> This Permit Expires 9 Year From Date Issued <br /> .............................. ...... !* E <br /> Application is hereby made to the San Joaquin Local Health District for a permit to copstrtiet and install the work herein <br /> described. This application is made In compliance with County Ordinance No. 549 End a isting Rules and Regulations+ <br /> :.t .! -- C'�NSUS TRACT ............ ....':.... , <br /> JOB ADDRESS/LOCATION .. ��........ .............. ...... _ .:....J..... � _ <br /> I_.......:... ..........::. ........Phone <br /> Owners Name ......... .l..v. --...:tib _ :. �. '.- <br /> f:; C '~ C°E .........� .........City ../ :!fir cCi ......__.. ... .. ............. ...... <br /> i�ddress ... ........_...�J.��...... -•--•• qV,��s•�� PhonI <br /> Cont actor's Nam® .... .�i... .......................................license e : <br /> Installation will serve= Residence Apartment House( Commercial(3Trailer Court 0 � k <br /> I Motel (Other............... ........ Jg <br /> x ' <br /> Number of living units:..... ---• Number of bedroom: ?....6arbage,Cninder ...... lot Size ........... ..............�: ..-... .;.... t <br /> Water Supplys Public System and name .............................— .................. .... ................................. .....Private , <br /> Character of soil to a depth of 3 feet= Sand( Silt( Clay'0 Peat E3 t. . SareLoam o Clay Loam E �s _3 ' <br /> ! Hardpan( Adobe( fill•M 3teriai..... '`.flf treb tYRe.......... ............. <br /> tPlot plan, showing size of lot, location of system In relation'to wells, buildings, ate. must be placed on reverse side.} <br /> E <br /> NEW INSTALLATIONr (No septic tank or seepage It ermittesl if: ublIc sewer is available within 200 feet,} <br /> N Pa9 P P p <br /> PACKAGE TREATMENT ( SEPTIC TANK I I_ Size::. .X.: ./��- :�„,........ epth ... ........... r <br /> Liquid D -.��.� •gyp '{ <br /> Capacity . ...... Tyle E< aterlal .:. . No. Compartments ...P-21........... I <br /> s .E^ =:` ..�...•...... . ,Foundation �.............•.... Prop. line <br /> .....................� �] � <br /> Distance �o nearest: Well ....- ..=• �- , <br /> LEACHING LINE ( j No. of i ine: .. ..... . �ngth of each line .r... ....... Total Length alp-..-..... •..N <br /> 'D' Box ]..... Type Filter Material��x��.. .Depth,Filter Material ... . , �-.....: :-..�. .. . <br /> n.aresh d...............I Property tine <br /> . , Distance to e- .. <br /> SEEPAGE ' .... Rock Filled Yes Q .No 00 <br /> PA PIT , ( } Depth . =Diameter .. Number .� .- <br /> Water Table Depth ......, •- --...J .................Rock Size .fi ........................ :a <br /> Distance to "a I sts Well i"oundation .................... Prop. line ......... ........ <br /> REPAIR/ADDITION(Prev. Sanitation Perr'llt# ......... .. .. .......... .......... . Date ........ ' : ....--•-•-•--•••• -1 <br /> Septic Tank (Specify Requirements) ... ........ .................. ............................. ._ . .................... .. ............_....... . ... <br /> { f}isoosol Field (S dfy Requirements} -. t ...._.::... ' ........ ........... - ..._. ..._................ ...................._.. ... <br /> ! } i ................................... .................... ° ................ <br /> ... .......... ...........I.... . ... — -._.........�. ••. .............................. <br /> :............... .... --- .... .. .. ...............� <br /> •..................... <br /> ................. <br /> ' (Draw existing and iequired addition on rbverse tide) <br /> I hereby certify that I have prepared thio application and that the work will he done In, accordance with San Joaquin <br /> County Ordinances, State Laws;-6rWltulez and Regulations of the San,Joaquin Isocal Health,District. Home owner or titers• <br /> sed agents signature certifies the following: �j i.s a' s V. ' <br /> "°I certify that in the performance of the work for which this permit is•issu4ed.'I-shot[ not employ any person in such manner <br /> as to becomei subject kma 's Come nsation laws of California." <br /> f� / ................................i ....... Owner ► d w ' .a <br /> By ...............................................................Signed . . '. _�.... t........................ Title ....................................`� �.._...... ....._....._ <br /> if other,than-owner( _ <br /> E RT HT USE ONLY <br /> ., t ...........-----....... DATE <br /> ......._ . . iF <br /> APPLICATION ACCEPTED BY' .- : '` :-_ "' <br /> BUILDING PERMIT ISSUED TE .:........... ..:....:---:...._._._.._. <br /> ADDITIONAL COMMENTS -- . ......_:_..._..: <br /> �* ........... <br /> _ ............... ........................... ... <br /> ................................ <br /> ..... ......................•----- -------------- <br /> I <br /> .... <br /> &7 'm <br /> .............. <br /> i Final Inspection b - -- <br /> Date .- .. .,2. . <br /> EH 13 2h 1--60 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT � <br />