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FOR OFFICE USE: <br /> - APPLICATION FOR SANITATION PERMIT <br /> ..........­­...... I <br /> ��I (Complete in Triplicate) Permit No. .7....-.�d�� <br /> A .�i I <br /> ._-_•1�,• This Permit Expires 1 Year From Date Issued Date Issued . 3. <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 it' made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS%LOCATION .. [ F/P- L. //�,- c ../- ..( _. j —�-- 1- ENSUS TRACT ................. <br /> Owner's Name ----- ..---•----- - •---- ......... -- ---Phonep.. r <br /> r_- A . <br /> Address ....._:_... "'R'"r�-�_Cf.� _ . • . ...�[ ---. i _. .. •- � ------•......-.............. <br /> .. �._ _. <br /> Contractor's Name .. .���� .-.cam-•-� -'----� -� � �'�--------------License # �-� ,� .�Phone /��--�:.,�..`�--�_.��• <br /> Installation will serve: Residence ❑ Apartment Housee�❑ Commercial ❑Trailer Court ❑ <br /> Motel ❑ Other .��j� ,:�'-/` ays.. •------- i <br /> Number of living units:.. ...... ... Number of bedrooms ,_._'-----Garbage Grinder Lot-Size -- .-.:?� i��. '•••--- =••• <br /> Water Supply: Public System,and name ........................ ............ ....---------- ----------------------------------- ...........Private Q <br /> � I <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 available within 200 feet,) <br /> 4 AV <br /> PACKAGE TREATMENT [ ] I�,SEPTIC TAMC f ] Size...__._._;7- 4-� -�.... ...00 Liquid Depth ..... .- <br /> 1 <br /> Capacity .. . .... ....... Type .............. Material Material _ . o: Compartments ..................... <br /> ---......... <br />` Distance to nearest: Well ..f q ._....._Foundation --_ Prop. Line ..„1 ... '.. <br /> ` ,a <br /> LEACHING LINE No- of Lines _ �� :_ Length of each line ....j�'....,Ca77:......_ Total Length <br /> • Bax ..... ...... Type Falter Material Depth, Filter Material ......I f................................. <br /> DI'Ance to nearest: Well -,_./ . f____ Foundation ..../ <br /> �//G�a ! ._..'._...-;. Property Line <br /> SEEPAGE PIT ( Depth 3 ./..,� Diameter Number Rock Filled Yes ©--- No ❑ 7 <br /> Water Table Depth .__:.1 . ` -------------------------------Rock Size -1.Dista .� <br /> ,.' <br /> !�. Well ----- --------_Foundation ------/0-....... Prop. Line .... - -•-- <br /> REPAIR/ADDITION(Prev San tation Perrmit# --- -------.................... Date <br /> pI° <br /> Septic Tank (Specify Requirements) .... •----''-• ..... ---_... ---- ----- ..........:.. <br /> its ------. ......... ........•-. -• _._I— <br /> F Disposal Field {Specify Requirements} ...........................__.... .......... - , <br /> ' <br /> ---------------- ........ ........._.......__._ ......-----•------------. .......... <br /> !Ili <br /> .- -- ----- ----------------------------------------- <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 /> i County Ordinances, State Laws, and Rules and Regulations of the' San Joaquin Local•Health District. Homs owner or licen- <br /> sed agents signature certifies the following:. a--- _--. - <br /> "I certify that in the performance of the work For which this permit is issued, I shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." - <br /> Signed .:_....*��han <br /> . ..I' Owner <br /> ----...__ Title . .... ................ <br /> i owner) <br /> F9R P RTMENTONLY <br /> — . <br /> — <br /> APPLICATION ACCEPTED B - <br /> ..._. DATE ................ <br /> . ..-. .......: ... .... .r....._..._. -.....-...... . _ �:.._»..._ :-- �... -- <br /> BUILDING PERMIT ISSUED ...... ...... ............ ................ = DATE . ............. <br /> ADDITIONAL COMMENTS..: 1 - -------- :... . :................ .. ._.._......................................_ ..-•--- <br /> t ------------------------ ---- ........... -- -. .._.-------- •....... ------ ............ .......... <br /> �� <br /> _. ................._.._�_ <br /> Final Inspection by: ... �`... _ -------------- =----._.........._._..._..... -Date . - �f <br /> SAN JOAQU LOCAL HEALTH DISTRICt <br /> FN_ 13 24 1-'68 Rev_ 5M :, <br />