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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT <br /> -------------------------- ------ Permit No. ..--J-1 9 <br /> (Complete in Triplicate) <br /> ---------- _ <br /> - • � -•� Date,Issued•-lD:_ <br /> - This Permit Expires 1 Year From date Issued - <br /> %.)k <br /> --------------------------�----- ---------------- <br /> Application is hereby made to the San Joaquin LocaVHealth District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and a ' ting Rules and Regulations: <br /> zz <br /> JOB ADDRESS/LOCATION . G :!',--/°�- '_�CENSUS`TRACT ------- --------- <br /> - <br /> Owner's Name ---- t Phony - R . <br /> ?-- ----- <br /> Address Ci V125 <br /> ,Q <br /> Contractor's Name / - --------------------------- License / 3 _ Phone __ - <br /> �� 3 <br /> Installation will serve. Residence Apartment House❑ <br /> Commercial OTrailer Court ;[] <br /> MotelOther -------------------------- --------------- <br /> Number of living units:---1-�_--- Number of bedrooms --g--__Garbage Grinder/_ _ �--0`�9 '------------------ <br /> - �. <br /> Water Supply: Public System:and nameYn_/ _ r, G_.j :---- -----------LotSize PtIvate ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Cay ❑ PeaU[Z Sandy Loam ❑"' Cla`y Loam ' <br /> ` Hardpan ❑ Adobe FiII.,Mate it al --_---__. -- If yes, type ---------------------------- r 4 <br /> (Plot plan, showing size of lot, location of system in gelation'to wells, buildings, etc. must be placed on reverse side.) ' a <br /> NEW INSTALLATION: (No p <br /> septic tank or seepage pit Permitted if publicseweris available within 200 feet,) <br /> p �i <br /> PACKAGE TREATMENT SEPTIC TANK Size- <br /> t�--------------------- Liquid Depth -----_--_----_---_--- <br /> P Y � --- TYpe j ---- Material Zohle/ ----- No. Compartments --�.............. <br /> Ca acit �- <br /> Distance to nearest: Well .____________'_________________Foundation -149_ _ . --_ Prop. Line <br /> LEACHING LINE [§� Na. of Lines ..-_____ - Length of each line___ IV g <br /> /i Len nn ---- ------ Total Ler�h ,�1w--------------- <br /> 1 'D' Box/45.- Type Filter Material1elOT Depth Filter Material/x-�-------------------••-•- --•--- <br /> S' <br /> Distance to nearest: Well _____`��--- ---- Foundation --- - -.---------- Property Line - -------------------- <br /> ��qq 6 <br /> SEEPAGE PIT [� Depth off- �---- Diameter�>�_�___ Number -___ '_________________ Rock Filled Yesr �,"No i❑ <br /> ... Water_Table Depth ----------------------- Rack Size <br /> Distance to nearest: Well __"--__"-��____-_-_-_-_--_-__Foundation8._,A9-P_ ----- Prop. Line --1 - ------------ <br /> REPAIR/ADDITION(Prey. Sanitation Permit�# -------------------------------------------- Date ---------------------- ------- <br /> Septic <br /> --- --Septic Tank (Specify Requirements) ------------------------------------ --- --•----------------- N_-------------------------- <br /> Field (Specify Requirements) --------------------------- --------------------------------------=--------------------------------------------------•--------------- <br /> --------------------------------------------------------------------------------------------- <br /> ------------------- --------------.=': ----- ----------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) 43 <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 /> "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." ,F, <br /> Signed ----- --------------- - r�"'--_---=--------Owner / <br /> a - Rf� - i <br /> �... .. ,. ------------- Title -- - ----- ---- <br /> JI <br /> -=----_----------- <br /> BY . e - - -- ------------- - <br /> i Ifo then`owner <br /> FOR DEPARTMENT USE ONLY '"" <br /> APPLICATION ACCEPTED BY ...--- . -',k4 ----- ------ --- -------------------------------------------------------- DATE ..iV---- ----------------------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------=--------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------- ----------------------------------------------------------------------------------------------------------------------------- <br /> ---------------------------------------------------------------------------------•--------------------------------------------- -------------------------------------------------------------- <br /> ------------------------------------ -------- ----- - - -------- - ------------------- --------------------------------------------------------------------------------------------------- <br /> I - ---- --- ---------- - -- <br /> - <br /> i .. <br /> �7 <br /> Final Inspection bY: ---- - I- -- ------------------------------ -----------------_-- ----�------------ -------,Date ---- ---�- - ---- ---- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />