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FOR OFFICE USE: APPLICATION FOR-SANITATION PERMIT <br /> 8 j-_: - --- <br /> (Complete in-Triplicate)te4 3ca Permit No. 73 7 Y <br /> -- <br /> .� ., )•:. <br /> --- <br /> ( - Date Issued --- <br /> w _____._._.__-_---------- ------ This Permit Expires' ] Year From Date Issued <br /> ! h District for permit to construct and install the work t ereir, <br /> Application is hereby made to the San Joaquin Local Heat P , <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION <br /> t .--------q1I: f ' r-----------------------------------CENSUS TRACT -----------------`--------------- <br /> �/ ----------------- -- <br /> Owner's9Name ------j -------—0- ----- ------------------------------ - ---------=-•--- ------Phone ----- <br /> Address - CitY - <br /> iE <br /> .SC?_ 1 <br /> 1 1 rr ,�-�.r.- _ <br /> Conteactor's Name----! 0 °_ l + A�--S �1 C77 P, License #" 7 I Phone <br /> f <br /> Installation will serve: Residence lX Apartment House❑ Commercial ,❑Trailer Court i❑ <br /> e <br /> F Motel ❑ Other { <br /> Number`.of living units:---- Number of bedrooms __�;_J-___Garbage Grind&�;___----____ Lot Size ____.J -- � �------- <br /> ..� ' <br /> Water supply: Public System and name --------------------------------------=A-!.----------------------------------- <br /> ------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt[IClay ❑-.....Peat.Q—Sand y Loam W—Cl& LbaW❑""`..'r. <br /> l Hardpan E] Adobe E] Fill Material ------------ If yes, type --------- ------------------ I <br /> ► <br /> (Plot1plan, 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 pili permitted ,) <br /> . if public sewer is available within 200 feet <br /> / e r �/ <br /> PACKAGE TREATMENT { ] ---- <br /> SEPTIC TANK Size--'------- ------ --- --- ----- -- ---------- quid De th ________ --:-------- <br /> p ' <br /> tacityype Material--- __ o. Com artments <br /> C d` ------ <br /> Distance to nearest: W&II' ti__ A ; ------ _40,?____:_,Foundation ----1 ' --- Prop. Line _ ..•-- <br /> LEACHING LINE ' { ],--N6. of Lines ----------------------- Length of each line'-- - --------------------- Total Length -------- _- <br /> D'-BOX-----=----- - <br /> --------------De --- e - + <br /> ___ Foundation Pra er Line _________________ __ <br /> T �-eFilter Material pt iter-- atena <br /> Qistance to nearest: Well ----- --------- � ------- -------- ---- i p tY �.r <br /> ' I <br /> SEEPAGE PIT C [ ] Depth ____________________ Diameter ______________._ Number Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ------- -------------------------- <br /> ----------- ------------Rock.Size-.--_---°_=------------- <br /> Distance to nearest: Well ------------------------------ p. ------------- <br /> ---------------- <br /> REPAIR/ADDITION <br /> _._______.Foundation _____________________ Pro Line _-.._______ <br /> -- '` <br /> REPAIR/ADDITION(Prev. SanitationiPermit# _------------------------------------------- Date ------------------------------- <br /> i <br /> Septic Tank {specify Requirements} --------- - `{ <br /> Disposal Field (Specify Requirements)"'__- --f--- <br /> ------------------------------------------ --------------------------------------------------------------------------- ----------------------------------------------------------------- <br /> _ ------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I 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 /> "1 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 1!1ws of California." <br /> OwnerSigned r -- <br /> .._ x <br /> ----- Title - ----- <br /> (If other than owner)! <br /> FOR- ARTMENT. USE ONLY <br /> APPLICATION ACCEPTED BY ----- - ----- --_ --------------- DATE _.__�--�--�7/___-_____------ <br /> BUILDINGPERMIT ISSUED ------ -- - ------- ---- - ------ - ---------- ---------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ----- -- ------------------------- --------------------------- --------------=--------------------------- <br /> - ------------------------------------------------------------------------ <br /> --------------- <br /> - ----- ------------------------------------- <br /> -- <br /> ------ ------ <br /> Date <br /> - -------Final Inspection by: AN�AQUIN <br /> LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. �- <br />