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FOR OFFICE USE: r <br /> APPLICATION FOR SANITATION PERMIT <br /> =° G <br /> ----------------- � Permit No. 7 =----9-- <br /> �Complete in Triplicate) <br /> -------------- - <br /> _M- <br /> -------------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> --------------- <br /> -0 <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 compliance with County Ordinance No. 549 and existing Rules and Regul6tions: <br /> JOB ADDRESS/LOCATION _ __,�_____We...._- �d�----,�r1 '7/.�6VENSUS TRACT __________________________ <br /> Owner's Name , � -------Phone ------------------------------------ <br /> - <br /> Address ----- -�'---- -----------------=--------------------------------------------•--. City ' <br /> Contractor's Name ------- f_ { 1r ------------=-----------------License #/P _ Phone _ <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court I❑ y <br /> Motel ❑Other -------------------------------------------- <br /> _ s <br /> Number of living units:----/_-__ Number of bedrooms _��_----_Garbage Grinder,,$�'e---_ Lot Size1Z9X_4e1R__ ------.--- <br /> Water Supply: Public System and name _eraZ�. -.-.la���" __a `moi �--------------------- <br /> ---A -----------------------Private El <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 /> (PI'ot 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------------------------------------------------ Liquid Depth -------------------------- W11 <br /> Capacity ---------= --- -- Type -------------------- Material----------------- ---. No. Com.n—_­+e <br /> Distance to nearest: Well -----------------------.------------Foundation -----------------:7 `CPVk nW a _ <br /> LEACHING LINE [ ] No. of Lines -------- ---------------- Length of each line---------------------------- Total'-,.Length ,_-------------------------- <br /> 'D' Box ------------ Type Filter Material ___----------------Depth Filter Material -_______------- t <br /> i <br /> Distance to nearest: Well�------------------------ Foundation ------------------------ Property -Line. ---------..-_--.--._..-. <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No [I <br /> Water Table Depth - y- --------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ---------- <br /> ------------------------------Foundation --------------------- Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit¢ --_-_..-.----!�--------------------------- Date -_-------------------------------) , <br /> Septic Tank (Specify Requirements) Ai____ . -. -------------------------------- <br /> I <br /> _ __________ <br /> ---- ---- ----- ---- -------------- --------------- <br /> Disposal Field (Specify Requirements)--------4 ------../e --.--��' ��� �. .������_ .l�__-_. <br /> A ---------I-------------------•-•- <br /> -------------------------- <br /> ---------------------- --- - - - <br /> -------------------------------------------•-----------------------------a„v ^----------------------------------------------------•--- <br /> (Draw 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: I <br /> �t <br /> "I certify that in the performance of the worVfor which this permit is issued, I shall not employ any person in such manner <br /> } <br /> as to become subject to Workman's Compensation laws of California.” 3 <br /> Signed ------------- ------- -----` -`-- Owner 4 <br /> �._ <br /> Y <br /> s <br /> B ------ Tittle - <br /> (If other n owner) <br /> { FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ C?--------------------- -------------------------------=`--------------------. DATE;---- 40.70,18'-�j--------- <br /> BUILDING PERMIT ISSUED g------------------------------------------ --• <br /> --------------------- -• f---•--------------------------DATE -J---------------------------------------- <br /> -- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------- --=-=-------------------------------=1'--------------------------------- ------ <br /> ----------------------------------- ` -----------------------------------------------------------------'--- ------------------------------------j`==---------------------------------------..._ <br /> ---------------------------------------------------- ------------------------------------------------------ -- ---------------------------------------------------------------------------------- <br /> -------- -- ------- --. _ ..__..- .. .---.. __ -------------------------------------------- <br /> / _-_-. .. -. _ _-__ . __ --------------- <br /> Final Inspection by: ----------- ------ dZ�--- ----- --- - - - ---- Date'..---------- ----- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ; <br /> E. H. 9 1-'68 Rev. 5M <br />