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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION- PERMIT - <br /> - ----- - ----- ..........z 9 <br /> _ r Permit No _� _Z <br /> ._-iiCbmp# r1 Tt�tp#io � _._ . _ ... . <br /> ---------- V� ............. <br /> Date Issued <br /> --- ---- ------- --.--- ---- ----------- This Permit Expires l Year_.From Doteissued <br /> Application is hereby made to the San Joaquin Local Health District for a..permit to construct and install the work herein <br /> descried. This application is made in compliance with County Ordinance -. 549 and existing Rules and 'Regulations: <br /> JOB ADDRESS/LOC`AT -:_ <br /> -,--- ---- CENSUS TRACT ,S ! ;......... <br /> Owner's Name = - ' ".,1.. ..------..... c..., x Phon G_" ............. <br /> 6 <br /> Ad � . <br /> Contractor's No ....... ..•- .......'!'>'i � ---•-_---•-._.License#1200, -....... PhoneFz'.. -X6•.. ... ......... <br /> Installation will serve: Residence NfApartment House-]'Com,h,4mial OTrarler.Court,,0 <br /> jj Motel 0 Other ---- --.........._......... <br /> Number of living unit$:---1_----- Number of bedrooms .. ._...Garbage Grinder ------------ Lot Size ... _ •_ -3----------- <br /> ., Water <br /> _-_----- <br /> , Water Supply. Public Systerry and name --• •--•--•.. ...............-------------------_--... _._--.._........... .. .........................Private <br />- Ch6t icter of soil to a depth of 3fee.- Sond'a __Silt 0----Clay {�- Pe�t� Sandy Loam Cloy Loamy -� - <br /> Hardpan❑ ' Ado 6e"[Xflit Mraterial `-- ---=- if Vw-,,tYPe...........---------------- <br /> (Plot plan, showing size of lot, Location of system in relation to wells, buildlrigs; etc.•must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public-sewer,ji,avoiloble within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK­1 Size -------------------- --_- .Liquid-"Depth ------ <br /> Mf No. Compartments ...................... <br /> Capacity --- ------- <br /> T <br /> Distance to nearest: Well ......- ------_•- - ._....... ... <br /> --_---- Prop. Line ................. <br /> ...... <br /> LEACHING LINE { ] No. of Lines ------------------ e---- 9 <br /> .•��ength of each {i _________ _ _________ Total Length .-_-.--- -............__._ <br /> V Box -------- --- Type Filter Material __ . ._...... .;.Depth Filter Material ............------...................... <br /> Distance to nearest—Well ...... --- --------'Foundotion , - . ------- Property Line :.__ __ .............. <br /> SEEPAGE PIT [ ) Depth --------------- - __ Diameter Number _ . --------- -------- Rock Filled Yes 0 No C] <br /> Water To a Depth ------ ------------------- ------- -------Rock Size <br /> Distance fie nearest: Well -------------------------------- .......Foundation_----------------- Prop. Line .................... <br /> REPAIR/AbRITION(Prev. Sanitation Permit# -•----••------------- -- __.____.. .._ Date ---------• •-_•------,--•.) <br /> Septic Tangy= pecify Requirements) -------- ----------------- -- ----•--- --- ---- - ------ •. ••• ---•- - j-------------- --------... _..... <br /> Disposal Field t6pecify Requirements) ...... <br /> ------ --------- - -1 � ( . : <br /> _. <br /> (Draw existing and required addition on reverte"gidet <br /> I hereby certify that I have ptilrpared"this application_'+end-tftat•;`the'' work will be done in accordance with San Joaquin <br /> County Ordinances,-State Laws, and Rules and:Regulailons of this Son Joaquin Local Health District. Horne owner,or licen- <br /> sed agents signature certifies the followings i <br /> "i certify that in the performance Of the work for which this permit is Issued, shall poll employ any-person In such manner <br /> ars to become subject to Workman's Compensation laws of California." <br /> .r <br /> Signed - Owner <br /> BY ------. -- - -•-_. ._...:.. Title = <br /> (If other n owner) <br /> FO ART ENT Y <br /> APPLICATION ACCEPTED B = -•=• ---.._ ,_ ......... ....•__-- --_-...t_.__ ._.. .. DATE ---- "' �•-- Z'............ <br /> BUILDING PERMIT ISSUED -• --.---•= •.•y ............. ............. --- -- ------ • -- ........DATE ••----... -•--- -=-- •--••--- <br /> ADDITIONAL COMMENTS <br /> ----- -------- -------- ------ - ---- --- •-•• -•-- -------- --- ,�..., .._.._.__ <br /> ... .......�• �'.._... <br /> �t7�5 <br /> . .... ....--- -•-- .... _. : <br /> Final Inspection by: .................. ----------• ........................ ..... -- --------• -- .........-_-•-•- ........Date.. -•- <br /> SAN JOAQUiN LOCAL HEALTH.QtSTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />