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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � <br /> ----- -------------- ----- <br /> (Complete in Triplicate) Permit No: <br /> This Permit Expires i Year From Date Issued 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 made-in-compliance-with C-ounty-_Ordinance.-No.--549-and-existing-Rules-and-Regulations: <br /> JOB ADDRESS/LOCATION � >b---ren--_R:o .'d. o __Frca ag,-e-.,boa.d.:_-.CENSUS-TRACT- _3:�---------------- <br /> r�e�iaeen Liberty & Collier Road <br /> Owner's Name --J rr Oo-x -. --- ------------------ -------------------------------Phone 369----------03------------- <br /> Address 32 3 as gine �S tr e� � j =" Ciiy -Lo d 1 --------------------- - <br /> Contractor's Name ---C_alnMes.tern�--Sar -.-----------.License # --ll;l-' 8¢------- Phone 179 1C-5--X83--SA71 <br /> Installation will serve: Residence [Z Apartment'House 0 Commercial�❑Trailer Court ;❑ <br /> ❑ Ot -------�--'--------- <br /> Motel her --- - .—----------. <br /> l �? - _, !�­. -- I <br /> Number of living units:-__1------ Number of bedrooms __3......Garbage*Grinder _ - -.--- Lot Size ---7 !___ ---5&a_!---------------- <br /> Water Supply: Public System and name-------------__-- --------_-_ _ -- - <br /> --------------____Private [ <br /> Character of soil to a depth of 3 feet: :Sand'❑ Silt E] Clay, E Peat❑ <Sandy loam ❑ Clay Loam ;❑ <br /> Hardpan ❑ AJobe ❑ .:-rill Material ------------ if yes, type ----------------------------i <br /> IE <br /> (Plot plan, showing size of lot, location of system i?- relation to wells, buildings tc must be placed o-n reverse side.) <br /> NEW INSTALLATION: {No septic tank or seepage..pit_.permitted if fewer ailable within 200 feet,) <br /> i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size----- -------------gal'.-QI1_: Liquid Depth --- ----_._-.- ----- <br /> Capacity 1400--Fa1Type -------------------- Material_-_C` w-re-te No. Compartments1.2.-_-_--_-_...__.- <br /> Distance to nearest: Well -_5Q_ -------------------------�-Foundation ----------------___ -- Prop. Line ---- <br /> LEACHING LINE [ ] No. of Lines -2._____-_._-_ ------ Length of each Jine1QO T------------------ Total Length _l.2IIt3-!--_---_.--_._-.- <br /> 'D' Box --.-.l----- Type Filter Material Con—OT-e_teDepth Filter Material ------------------------------------- <br /> ------- <br /> Distance to nearest: Well - _- -5D;------_/Foundation ------------------------ Property Line --j- --- ---------------- <br /> t <br /> SEEPAGE PIT [ ] Depth ----25 fD -- Diameter 3-i1 �---.-- Number -------2------------------ Rock Filled Yes a No 0 <br /> I I <br /> Water Table Depth ------ i --------------------------Rock Size ---c_ohb-le---------.---- <br /> Distance to nearest: Well---------d�t------------------------Foundation --------------- ---- Prop. Line --------------:........ <br /> REPAIR ADDITION <br /> {Prev. Sanitation Fermat -_ ------------------------------------ -------------------------- Date1 <br /> # _,--_�-..-- -_ <br /> Septic Tank (Specify Requirements) ` ------------------------------------------------------------- <br /> Disposal Field (Specify. Requirements) ---------------------------------L---------------------------------------- --------------------- ------------------------------------- <br /> ------------------------------------------=----------------------------------------------------------------- - <br /> ---------------------------------- ---- ----------- ------------------------------------- <br /> ----------------------------------------------------------------=-------------- ----- <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: <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." .mow <br /> Signed ate _ '- :-tion -nom•-------------------- Owner <br /> BY --•---- -- ....... -- -------------------------------- Title -- ,fre all-edit--------- ------ ------------------------ <br /> (1 other than ow r) <br /> - FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y DATE7 ---------------- <br /> BUILDING PERMIT ISSUED -------------------------------------------------------------------------------- ------------------------DATE ---------------- -------------------------- <br /> ADDITIONAL COMMENTS -------------------------------------------------------------------------------- ------- ------------------------ ----------- ----------- <br /> - -------- <br /> ,i <br /> -----------I-------------------- -------- ----- --------------------------------- --------------------------------------------------------------------------------------------- <br /> ----------------------------- - ------------------------------------------------------------------ <br /> - <br /> Final Inspection by: - -------------------------------- ---- ------------------------------------------.Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f <br /> E. H. 9 1-'68 Rev. 5M. <br /> 4, <br />