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FOR OFFICE USE.- <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate) _.PermitNo. .7r. ....... <br /> I This Permit Expires'l Year From Date Issued Dote Issued <br /> --------------------- I <br /> Application ;s hereby made to the San Joaquin Local Health District for a per'mit to construct and install the work herein <br /> described. This application is madelin compliance with,,Count Ordinance No.`549 and existing' Rules and Regulations, <br /> 14 11 <br /> /.. "' <br /> . ....................................`...CENSUS TRACT ............ <br /> JOB ADDRESS/LOCA7 6N ...... <br /> ................................. .................................. <br /> Owner's Name ........... - - - —­ -------­--­-------------- <br /> ............... ................. .. <br /> Address ....................­ .........w.ZL(c-c�.............. City .................... <br /> Contractor's Name . ...... _.d.9.......... ..... ....4...................License # �.?/___!�;Phone <br /> Installation will serve: Residence partmeM House[] Commercial OTraller Court 0 <br /> Motel E]Other ..................................... <br /> Number of living vnits...)------ Number of a s Garbag Grinder . Lot Size'f <br /> Water Supply: Public System and name ... ..... ........ . .7..... ....................... ..................Private 0 <br /> Character of soil to�a depth of 3 feet; Sand❑ S tit <br /> Clay C] Peat❑ Sandy Loam 0 Clay Loam 0 <br /> f. jHardpan C].. _Adobe 14�MW61eriol •--- yes, type ............................. <br /> -6 <br /> .0. - side.} <br /> NEW(Plot plan, showing' size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse <br /> NEW INSTALLATION-,, .(No septic tank or seepage pit perMI4;d' If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ,j ) SEPTIC TANK( ] Size---------------------------------- •------------ Liquid Depth ......_.................. <br /> Capacity -- ---- ------------ Type -_-----_----z... Material...................... No. Compartments ..........-1......... <br /> Distance- to nearest.—Welly_nz:,...........................Foundation ...................... Prop. Line -----------__ ...... <br /> LEACHING LINE No. of Lines ------------------------- Length of each line.___.___._._. I.......... Total Length ............................ <br /> kA <br /> 'D, Bax x-------- -Type Filter Material ......................Depth Filter Material --------.--•--------------._._....._........ <br /> Distance to nearest: Well ............. ........... Foundation ........................ Property Line. ........................ <br /> SEEPAGE PIT Depth ..................... Diameter Number.._...:___.:__._:_... L.. Rock Filled Yes ❑ No (3 <br /> Water Table Depth ................................. ----------.-..Rock Size ................................. <br /> Distance to nearest: Well_---..._._:....................... ...Foundation .................... Prop. Line _...._.._...•. <br /> REPAIR/ADDITION(Preva Sanitation Permit# ............................................ Dote ..........:....................._.I <br /> Septic Tank (Specify Req u irem ents) ----------------------------- ..... ........ ---- -- ...... ................. 7......... <br /> Disposallied Specify. Req _--—- -- ------ ----------------------------- I..... ....../..............4...... ........ <br /> ------------------ ........ . .......... ........... ............................. <br /> .... ... .; <br /> _�. <br /> ............... -----------------------------------..------I. ................................I..............--------------------------------- ....... .. . . ..... . . ........... <br /> (Draw existing and required addition on reverse side) 0 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State 'Lows, and Rules and Regulations of the Son Joaquin,Local Health District. Home owner or licen- <br /> sed agents signature-certifies the following: <br /> "I certify that in the piirformance of the work for which this permit Is Issued, I not employ any person In,such manner <br /> ,6 issued, n, <br /> 1, <br /> as to become subject to Workman's Compensation laws.of California." <br /> Signed .... 0 <br /> ........ - ------ ................................ er <br /> 0( ri <br /> t <br /> By ..... ............. ------ -------- ------ ................. <br /> - <br /> Tit e ....... . .. ............ <br /> of r than owner)'_- <br /> 04 ffOR DEPARTMENt'.U-SE ONLY <br /> APPLICATIOVACCEPTIE-D 'BY -. 'Z 2 <br /> 1 - :: ....... ..�".' - , - ,- - <br /> BUILDING PERMIT,ISSUED - . 1. ..41---�_ i............................................... DATE <br /> ---k----------I--------------- <br /> ------"I---------------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ............................. ......... ... .. .. ­...... ........ .. . -- ----------------:.......................................... <br /> ............ .... .... ------ - --- <br /> ....................................................... <br /> ............................A.. <br /> .. ...... <br /> ....................................... ......... .................. ... <br /> ........... .............................................. . .. .......... <br /> ... .. . .................................. <br /> -- ----- ----.Date Final Inspection by: .......... ....... . ... .. .................... <br /> S J QUIN LOCA <br /> AN OA22L ALTH DISTRICT <br /> r w 13 24 i.-Aq P.,, gm 7/72 3 X <br />