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FOR 0iFF.1Cf USE: APPLICATION FOR SANITATION PERMIT permit No: <br /> (Complete in Triplicate) <br /> ------ -- ---- <br /> Date Issued -. �s-- <br /> -------------------- ---------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> describedJ This application is made in compliance with County Ordinance No. 549 nd existing Rules and Regulations: <br /> q13 R— <br /> JOB ADD RESS/LOCATIfs _7_ - -----CENSUS TRACT -------------------------- <br /> Owner's Name c I� G /B r ,2-- ----------------- ---------------------- -- -- ----- hone ------ <br /> ---- - ------------ ----------- ---------------- ,% <br /> (� ._ °----------------------------------------- <br /> Address . Cit E <br /> ���. �---�_ digY <br /> -i. <br /> Contractors Name --- .Te-•---- --------------------------------------------License #(- --- Phone <br /> Installation will serve: Residence �rtment Mouse,❑ Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units-----------I Number of bedrooms I---------Garbage Grinder,, ----- Lot Size -tom-�_- . <br /> 11 <br /> Water Su ply: Public System and name -------------------------------------------------------------•-------------------------------------------------pp. <br /> i00 E v r <br /> sof soil to a depth of.3`feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C�y Loam <br /> - r <br /> H�'rdpan ❑ Adobe ❑ Fill Material __ If yes, type ________"__________ _ <br /> arac#er <br /> f <br /> (Plot plar , showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placedn reverse side.) <br /> �.s <br /> NEW INSTALLATION: (No septic tank or seepage;pit permitted if public sewer is available within 200,feet,) <br /> PACKAGE. TREATMENT [ � SEPTIC TANK'[ e--------------------------------------------- -- Liquid Deph ----_------_-------5iz ,--- <br /> Capacity ------------ -------- Type --------------------Material------------ ------ No. Compartments ------ ---•----- •�.� <br /> Distance to nearest: Well ----------------------- - --Foundation ---------------------- Prop. Line -------------- ------ <br /> LEACHING _ <br /> LINE [ ] No. of Lines ------------------ ---- Length of each line-.-------------------.-" -- Total Length---------------•------------ <br /> 'D' Box ------------ Type Filter Material --------------------Depth. Filter Material --- -- -------------------...... h1 <br /> i <br /> Distance to nearest: Well _______________________ Foundation �- ProP rtotine _______ <br /> SEEPAGEIPIT [ ] Depth -------------------- Diameter ---____________ Number ----__.__------:------- Rock Filled Yes ❑ Is ❑ +1 t <br /> Water Table Depth ------------------------------------------------Ro& size ------ ---' <br /> Distance to nearest: Well --- ---.----- --Foundation -------------- Prop. Line ------------- ------•- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------_ =-- -- --- date -_- I~------ ____--------------I 77 <br /> Septic ank (Specify Requirements) ------- -------- <br /> ----------------- ----- --------- <br /> .� -----------------"----------------- <br /> Qisposa Feld (Specify Requirements) L .. <br /> _ ` - -------------------------------------------- ------- --------------------------------�------------_-------•-- <br /> ��hl/ I ----------- <br /> ---------------------------------------------------------- <br /> (Draw ai <br /> -.. . PP _ required addition on revers +idey <br /> PW <br /> I hereby'certify thall�have._prepared this a lication and that the work will be:*do a in accordance with San Joaquin <br /> i existing and <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lodl Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify!that in thel:perfotmance of the work for which this permit is issued, I shalnot employ any person in such manner <br /> as to become subject to Workma is Compensation laws of California." <br /> Sgnekd -- Owner ` <br /> ----- ---------- ----------------------- -------------- <br /> kTitle :_..---------------------------------------- <br /> f ---- -------------------- <br /> i (If oth t an owned <br /> ------------------- <br /> APPLICATIONf FOR .DEPARTMENT USE ONLY <br /> t BL ACCEPTED BY - -- -- ----------------------------------------------------------------------"----------- DATE as'� <br /> a G PERMIT ISSUED ----- ------------- -- ____DATE ------- --- <br /> q f <br /> 1c r . �-s ---`�-�---- ------ ------- ------ <br /> ------ -- -- <br /> ADQITIONAL COMMENTS ��r_,c� '_'��. � rr'"' '`" ��'`�_ :- <br /> --------------� � - <br /> r ---------------------------------------------------------- <br /> --------- ---- --------------------------------- - _ <br /> __ ---- <br /> Final Inspection by: __ =-------------------------------------------- -- -- -------------------Date � <br /> i SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> G 'I <br /> # E. H. 9 I 1-'68 Rev. 5M �� •' i\ '`° ._'��' w'4 31� y� ' ».� ' -- <br />