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FOR OFFICE USE., i%., <br /> 3 : 3 0 APPLICATION FOR "SANITATION PERMIT <br /> ------------------------- ---- - Perm �71_ <br /> ------- (Complete in Triplicate) it No. <br /> ----------------------------------------- ---------- This Permit Expires 1 Year From Date Issued Date Issued _� _J-71 <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 93M liance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ----------CENSUS TRACT --------------- ............ <br /> Owner's Name _V_Tl;✓7 ----------------------------------------------------------- ---------------Phone ------------------------------------ <br /> Address ...... ---------------------------- --------_. city ------------ <br /> Contractor's Name ----------------------------- <br /> 71-211-10----1-0------- ----------------------------------License 0,4�fxqx--- Phone <br /> - F_- <br /> Installation will serve.. Residence Apartment House,❑ Commercial F­lTrailer Court El.- <br /> Motel7 Other -------------------------------------------- <br /> Number of living units.---/----- Number of bedrooms --%-7-----Garbage Grinder Lotsize ------ <br /> Water Supply: Public System and nameP-47�-------ae----------------------------------------------Private El <br /> Character of soil to a depth of 3 feet: Sand'E] Silt F] Clay E] Peat E] Sandy Loam ❑ Clayl6am V <br /> t Ir­ <br /> Hardpan E] Adobe E] Fill Material ------------ If yes, type _______________>-__________ <br /> (Plot <br /> -------------- ----------- <br /> (Plot plan, 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 /> PACKAGE TREATMENT SEPTIC TANK.� Size_4V,'X-_;r- X ------------ Liquid Depth Y ----------------- <br /> Capacity Type <br /> Material No. Compartments ...........-- <br /> Distance to nearest: Well ---- --------------—------------Foundation -/a Z , <br /> ------------ Prop, Line -----5:7 <br /> LEACHING LINE No. of-Lines -----.2—------------- Length of each line---7V__1---- ------ Total Length etre' <br /> X <br /> 'D' Box Type Filter Material/"_ _0_&06Depth Filter Material ,_,7P'14-------------------------- <br /> 0Y el - le <br /> Distant 6 to nearest: Well ------------------------ Foundation -------- --- Property Line _4---------- <br /> .1 V 2 <br /> juSEEPAGE PIT Depth -------- Diameter -------- Number ---------------------------- Rock Filled Yesk No .C] <br /> A7 <br /> Water Table Depth ------�tdef_ -------Rock Size �_--- <br /> Distance to nearest: Well ----------------------------------------Foundation ------------- Prop. Line ..... ......... <br /> REPAIR/ADDITION(Prev. Sanitati'on Permit# --- ---------------------------------------- Date -------------------- ------------- <br /> SepticTank (Specify Requirements) ------------------------- -------------------------------------------------------- ---------------------------------------------------------- <br /> DisposalField (Specify Requirements) --------------------------------------------------------------------------------- --------------------------------------------------- <br /> -------------------------------------------------------I------------------------------------------------------------- ------------- ; I--------------------------------;--------------------------------- <br /> -------------------------------- -------- ----------------------------------------I------------------------------------------------ <br /> ---------------------------------------------------------------- <br /> (Dr6w 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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------------- - --- ----------- ------------------------------------ Owner <br /> By ----- ------------------------ Title ------- 7_..,---------------- <br /> ------------------------------ ---- - --------- ---------- <br /> (if at than ow PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ------------------------------------------------- DATE ------7 7--------------------- <br /> BUILDING PERMIT <br /> ISSUED ---------- ------DATE ------------------------------------------- <br /> ADDI�110�/A COMAMNA------ --- - -------- --- -- ----------------- <br /> --- - <br /> ------------------------------------------------------ <br /> -------------------------------------------------- ------- <br /> ---- -- --------- ------ -- ------------------------------------------ <br /> -------------- <br /> --3- _ i_� <br /> ---- ----- - ___0------ - -- ------ A t4- <br /> ------- --- ---------------f------- --- --- -- --- - ------------------------------------------------------ <br /> ------------------------------------- ----- -- - -- - --------------------------------------------------------- <br /> Final Inspection by: --- ------ --- ................ <br /> -------------------•------ ------:_.Date ---3r -- <br /> ------ ----------- <br /> ibAQuIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68-.Rev. 5M <br />