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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No.. <br />.......... -------------------------- <br /> ----------------- Date Issued <br /> ------------------------------ <br /> J This Permit Expires I 'fear From Dole Issued,A?-1—,Vy- -2-,/ <br />---- ----------------- <br /> t and install the work;herein <br /> Application is hereby made to the San Joaquin Local.Health District Jor.a,permit to iconstru <br /> described. This appjication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> ZACT�,CX__�.- <br /> -CEN9T <br /> /2'2 &ESPSILOCAVION 40 JY-0�&J---- <br /> J09 AD <br /> Owner's Name --------- ------------------------------ -------------Phone ---------------------------------- <br /> ------------- --- <br /> --------14-1 ------------ <br /> Address ----------------------------- ------------------- City ----------------------------------------------- <br /> - <br /> nse #ck-97 ---- Phone <br /> ---------Lice <br /> Contractor's Name ---- <br /> Installation will serve: Residence PqO;Cp'-artment House f-1 Commercial [DTrailer Court ,E] <br /> Wotel F-]Other ----------------------------------- -------- <br /> i t Size --------------- <br /> Number of living units:-----/---- Number of bed p i oms ;�­­-Garbage Grinc1er,,y­14`*-­Lo ----- <br /> ---411( t13 ::�A ------ ---------------------- ---------Priv6te,[D- <br /> Water Supply: Public System and name ---------C-4t --- --- ------ <br /> Clay Loam El <br /> Character of soil to a depth of 3 feet:� Sand'E] Silt F y F� Peat[I Sandy Loam �El <br /> J Cia <br /> Fill Material <br /> Hardpan.E].-:--Adobe,[ir"' ---- If yes, type ---------------------------- <br /> must be_placed on reverse side.) <br /> (Plot plan, showing size of lot, loccli—ion. oflgystem relation to wells, buildings, etc. r <br /> 00 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available witl�ri 2feet,) <br /> ------------- <br /> Size Li-u id W6pt <br /> PACKAGE TREATMENT SEPTIC TANK Size - ----------I-------- <br /> -kll :--Ty 4ke ! Material---- Compartments --------•....... <br /> Capacity ---- ------------ <br /> kfft---------------Foundation ------0-1------- Prop. Lin ------------------ <br /> Distance- to nearest: Well ---------F---- . - I <br /> I k .11, ---- --- - ------ Total Length 7----------------------- <br /> No. of Lines '-------)----------- Length of each line------_ ---- <br /> LEACHING LINE # I I­� I <br /> -�� C-) ---Depth Filter Material -__)-0------------------------ <br /> 'D' Box Type Filte�rA`,`MaterialNN I <br /> E--------------- <br /> -------_17 Jine <br /> Well ------- -r.opprty <br /> Distance to nearest: ,Wel! �-eT­----FoundatJon---4 e J-`-N-o [3 <br /> `1?i cilm%e rL"/- <br /> j�� I Rock Filled Yes <br /> SEEPAGE PIT +#p"' Depth -11W------ Number J/ <br /> ------------ <br /> Water Table Depth I....... . ----------------------- --------Rock Size <br /> Distance to nearest: Well ----p---1-4----------------------Foundation ------ Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------- ----------------------------------- <br /> Septic Tank (Specify Requirements)---------------!------------------------------------------------------------------------------- 7 <br /> --------------------- --------------- <br /> Disposal Field (Specify Requirements) ---------------------------- -------------------------------------------------------,----------- <br /> ----------- -------------------------------------------------------- <br /> -------------------------------------------------------------------- <br /> ----------------------------------------------- <br /> F� ---------------------------------------------------------------- ------------- <br /> ------------------- <br /> -------- ---- -- - - - - - ----------- <br /> --------------------- ---- ------------ -------------------Draw-exi-st-i-n-g--a-n-d--required addition on reverse side) <br /> I hereby certify that I have prepare&this application and that the work <br /> will be done in accordance with?Scin 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: d, I- sholl'not employ any person in such manner <br /> "I certify that in the performance of the work:for which this permit is issue <br /> as to become subject to Workman's Compensation laws of California." <br /> ---.--Owner <br /> --—------------ <br /> Signed -------------------- ------------------------------N. <br /> By --------------------- --------- <br /> ------ Title <br /> (if other # a n�e r) <br /> FOR DEPAitTMiEN'T USE ONLY <br /> ---------- <br /> DATE -- ----- <br /> (�4 ---------- ---------------------------------------------- <br /> ....... ............ <br /> --;------------ <br /> APPLICATION ACCEPTED By ------------- --------- i DATE -------------------------------------- <br /> BUILDING PERMIT ISSUED -----------------------------------:-------- ------I----------------------- <br /> I �. ;1 --------------------------------L--------------------------- <br /> ADDITIONALCOMMENTS ------------------ ---------------------------------------I----------------------------------------- 0 --------------------------------- <br /> ----------------------------------------------------- -------- <br /> ---------------- ------------------------------------- -------------------------------------------- - 0 <br /> ----------- ------------------------ <br /> ---------------- ------------------------------------- -- ------- -- --------------------------- ------------------------------ Z <br /> ----------------------------------- -------- - <br /> ------ <br /> ------------------------------- ----------- <br /> ------ - - - --------.Date <br /> t <br /> Final Inspection by: - <br /> - ---- --- <br /> SAN JOAQUYLOCAL HEALTH DISTRICT <br /> t wqlb <br /> E. H. 9 1-'68 Rev. 5M <br />