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FOR OFFICE USE: APPLICATION- SANITATION PERMIT
<br /> 7777 - APPLIC
<br /> - -
<br /> - - --- = -------•----�E?�--7777-- � ,Permit No,
<br /> �... - (Complete in-Triplicate)-. —
<br /> -
<br /> A----
<br /> - ------------------------------_____- _---_---------------- This Permit Expires 1 Year From Date Issued Date Issued
<br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein
<br /> descHbed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:
<br /> JOB ADDRESS/LOCATION . 03-0�_.�� - - 7777-- CENSUS TRACT
<br /> Owner's Name --- -------- zagz ---------------------- :--------------- -- -- --------Phone----4., l - -------
<br /> Address ---------1-------=--- ------- ------------------ -------- ------------------ � City ----- ---`------------------•-- --==------
<br /> 1
<br /> Contractor's Name --- r ---- +- 1 --.License # Phone f4� -----------
<br /> Installation
<br /> ~?Q Installation will serve: Residence [ Apartment House❑ Commercial :❑Trailer Court iQ l
<br /> t
<br /> Motel ❑ Other --------------------------------------------
<br /> N
<br /> ------------- --------------------------- E f
<br /> ,;p < �
<br /> ' Numjber of-living units:_-_�___.._ Number of bedrooms _:___Garbage Grinder ____— Lot Size -- ---------------------------------
<br /> Water
<br /> ��4
<br /> . ,., V�. � 1 � .j ----7777-- ---- ------7777-- - --._..
<br /> Private
<br /> Water Supply:,Public System and name --------------- ----- ------------ -- �--------- -------------- ❑
<br /> Character of soil to a de`p h of 3,feef _j� .San$d°5❑ Silt❑ Cla j❑ Peat ❑ Sandy:foam ❑ Clay Loam_❑
<br /> J J ..
<br /> Hardpan ❑-- Adobe F.ill�Material 7777,,,Sandy
<br /> type--------------------------- I
<br /> (Plot!plo'n, showing size of fot, location of system in relation to wells, buildings, etc, must be placed on reverse side.}
<br /> NEW INSfXLLATION: '(No septic tank or seepage pit permitted if public sewer is available within 20b feet,)
<br /> 3
<br /> PACKAGE TREATMENT { ] SEPTIC TANK'[ I Size__________________________________-__----- --- Liquid Depth ------------------
<br /> Capacity ----------- TYpe -------=�--- Material Na �Comp'artments = =
<br /> --.4 `•"'.�"�� � F -------r/--�-�--� ��.y y - - - - y� o �9 �---'�:.-7777--
<br /> LEACHING LINE Q-,of Lines Len th,•of, each line---_- � ---- -- To'aI.Jen h _---/V
<br /> w
<br /> t,`Distance to. nearest:,,Well. 77777777. 777.'--------------_____Foundation ----_____-__-",�:_..-.,PrQ Line _
<br /> --------
<br /> .-D','Box ---- Type Filter Material _--- - 7777--.Depth Filter Material ------- --------------
<br /> [Distance to nearest: Well -----77^7^7 Foundation ------v-G--------------- Property Line. ---/ -.--_---_.._.
<br /> r�
<br /> SEEPAt,E 01,1 [Kj Depth,__149......... Diameter _ z_ ' G?__ Number ------------l------------- Rock Filled .Yes ® No i❑
<br /> S --------------
<br /> G ---- Roc --------------------
<br /> Water Table Depth ---- _______-Q __ .1, �'
<br /> ' k Size
<br /> - 7777-- - --
<br /> .,_._..,
<br /> Distance to neare t: Well -------7777__-----------------------Foundation k/c4---__ Prop./"Line ----- -----------
<br /> `
<br />+ ,REPAIR/ADDITION(Prev. Sanitation Permit•,# -------------------------------------------- Date 7777_________--------------
<br /> �
<br /> r � c i
<br /> Septic Tank (Specify Requirements) ------.----- _ �y�c.i_ -�-- --------- ------ --------------------------
<br />`
<br /> Disposal---F--i-e--ld---�(Specif7y777_'Requirements) {k
<br /> ---------ld;!4 --11 � -- --------------------}---------------- -, �-----t--�--- '--.-�
<br /> --------
<br /> 'li -----------------------------Nt---------------------------- ----Y------------------/--------------/----------------------------
<br /> -------------------
<br /> -=------------------------------=---------
<br /> -- ------ -------------------- --------------------------------------------------------------------------------"----------------------------------------- --- ------------=---------
<br />} 4 t (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 Mules and Regulations of the San Joaquin Local Health District. Home owner or licen�
<br /> sed agents signatme.certifies the followings a
<br /> "1 certify that in the Oerformance of the work for which this permit is issued, l shall not employ any person. in such manner
<br /> as to�become subject;to Workman's Compensation laws of California."
<br /> g I. . Owner
<br />�
<br /> Signed -----------------'-
<br /> ----------------------7777-.---------------------------------------------
<br /> By ! ----------} ---------------I__-- ---- Title --
<br /> -- -----------
<br /> ----------•7777--7777-- -----
<br /> (If other than owner)
<br /> FOR .DEPARTMENT USE jPNLY
<br /> APPLICATION ACCEPTED BY f ..... DATE " ---------
<br /> BUILI ING_PERMl7,,.ISSUED ------�- ' -<--- --(------C/------ :. - - ---------------------------------------DATE--- ----------------------------------------
<br /> ADDITIONAL
<br /> -----------ADDITIONAL COMMENTS --------------------------------------------------------- - ------ ------------- - -- ------------- --- --
<br /> - - - - --7777-- - 7777- - - ----•---
<br /> ---------------------------------------------------lkn2.z-,7z.-----�s�. 000 -----------------------------------------------------------------------------
<br /> ------------------------------ --------------------------- ------------------------------------------------------------------------------------------------------------
<br /> ------
<br /> ----7777-- --- - - -- 7777-- ---
<br /> - - - - ����--
<br /> f Final Inspection by: ---.-_---- - __ Date _.- "---- -- /T-- 7777--
<br /> - --------------------7777-- - 7777 7777 ----
<br /> -------------------------------------------
<br /> SAN JO 'QUIN LOCA&,HEALTH�DIS, RICT,,
<br /> E. H. 9 1-'68 Rev, 5M
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