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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> A­­­A­ . ..... Permit No. ..... � <br /> (Complete in Triplicate) S, <br /> .?, <br /> Date Issued ..� .............. <br />.... ..... -. _--•................ "' This Permit Expires t, 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 /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..A.�C = CENSUS TRACT .......................... <br /> Owner's Name ........ JA.T..fi�c�.u ............................... ........................... ....Phonef�Z-.3! 7 ..... <br /> Address _ _ J��.r a�....._�}.Gh� �_ AI_,'- ...... .. ............ ............ City .............................................. <br /> Contractor's Nome ..41 .14I.J. 4M4445�1 '_._ _ ...... - ----.License #,;1,96_51r A.. Phone <br /> Installation will serve: Residence og Apartment House❑ Commercial []Trailer Court <br /> Motel ❑Other C <br /> Number of living units: .... Number of bedrooms ............Garbage Grinder Lot Size ... . ..... .............................. <br /> " <br /> ` <br /> Water Supply: Public System and name ---._•.-- <br /> ..Private <br /> __��-'.k�.l.(�.?91.y'�:.i.:.....��.t�_t7�_.-..--• •...................•----.-....... ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam (� <br /> Hardpan ❑ Adobe ❑ Fill Material .. If yes, type - <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.--6_k9 1.K -..-.-- ---.-- Liquid Depth ... .......... <br /> Capacity/�24-�V _ Typer-X IC45_ _ Material._. ... No. Compartments ..... <br /> Distance to nearest: Well _... .................Foundation . ?-- Prop. Line ..14- ......... <br /> LEACHING LINE [ ] No. of Lines Length of each line` p-..- Tota) Length ............. <br /> 'D' Box Type Filter Material /f y ...Depth Filter Material _ .._..__:...................... 0 <br /> Distance to nearest: Well ........ Foundation vll F. ......._.. Property line .,-,2.`............ <br /> SEEPVE PIT [ ) Depth _. Diameter -�............. Number __.. _ ------ Rock Filled Yes , No 0 <br /> Water Table Depth --_- �.............Rock Size ............................... <br /> - <br /> Distance to nearest: ell __-. -- .--.-- .•..................Foundation Prop. line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -.--.-.- -..- - _ --- ------ --------- Date _- ---------- ) <br /> Septic Tank (Specify Requirements) -- ................................ F <br /> Disposal Field (Specify Requirements) - ...... ................ --- <br /> ...-- ..._.. _ - __..- - ---- -- ----­------------- -__ _ <br /> (Draw existing and required addition on reverse side) <br /> 1 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 /> "1 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 sublec o W main/'s Compensation laws of California." <br /> nSigned ...... ........ Owner. - --- <br /> ., <br /> BY . - -... -_.... _...__._ _..._..-- _........ _.. Title <br /> (If other than owner) <br /> MR DEPARTMEN USE ONLY <br /> APPLICATION ACCEPTED BY _ . ._ _ _ _ _. DATE <br /> BUILDING PERMIT ISSUED , _ _._ __.. ..__.._ . ._.. .._ . :. . _. _ .. ... ...DATE -_--_---- - _ _.---.-..-.-. <br /> ADDITIONAL COMMENTS _. •..... ....... <br /> ------ -------- _ .... .... ........:...... ..... --- --- ............ ...... <br /> . . • .... ... . . ........... . _ _ ._ .. _.. - ........ ...... <br /> ------- ---------........ ....... - .. . <br /> --............ <br /> . <br /> ...Date .... �� . ,............. <br /> Final Inspection by: .. . . ..... - . <br /> SAN JOAQUIN L AL HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 7/723 ,14`�/ <br />