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FOR OFFICE-USE. <br /> I USE:7�R OFFICE APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> FOR <br /> (complete in Triplicate) Date Issued <br /> - - ------ ---- -- - <br /> -- - <br /> ---------------------- <br /> -------- <br /> ----------- This Permit Expires 1 Year From Date Issued <br /> ---- --------- <br /> . .. .............. ----- "_� <br /> -----------------------------------------I------- <br /> i ruct and install the work herein <br /> Application is hereby made to the Scin Joaquin.Local Health District for a per'mit tO const <br /> described. This application is made in complianEe�with County Ordinance No 549 and existing Rules and Regulations: <br /> ___CENSUS TRACT -------------- ----------- <br /> 2 or�_ <br /> JOB ADDRESS/LOCATION ---1�7 ----- - ----------------------- <br /> Phone ----•-- <br /> Owner s Name <br /> ------- ------ City <br /> Ne --- ------- ---- --- <br /> Address _z7_'_ -----.License # -- <br /> I ----Phone <br /> Contractor's Name ---- 1 .0Trailer Court 0 <br /> O'Apartment House 0 <br /> Commercial Installation will serve: Residence .4. <br /> MotelM Other ---------------------------------------- <br /> t' <br /> Lo <br /> bedrooms --- -------- Size ---------------------- <br /> __;;�---- Garbage Grinder <br /> Number of 1livirig­units-____/---- Number of <br /> ---------------------? 4 <br /> Private5?` <br /> Water Su�ply: P�blic System and name ----------------------------------------------------------- ' <br /> ------------- <br /> I Sand�E] Silt 0 Clay E1 Peat El Sandy Loam E:1 CIOYLoam o I <br /> Character of soil-to a depth of 3 feet: <br /> Hardpan E] Adobe Fill Material -----I------- If yes,type ---------- ------------- <br /> rtFx <br /> must be placed on reverse side.) <br /> L r!I <br /> (Plot plan, showing size of 16t, location of system in relation to wells, buildings, etc. <br /> ge pit permitted if public sewer is available within 200 feet, <br /> septic.tank or seepage 4 <br /> NEW INSTALLATION: (No s Liquid ------------•--------.-----PACKAGE TREATMENT I SEPTIC TANK:[ Size---------------I--------------------------------- <br /> Material <br /> ------------------- No. Compartments --------- <br /> Capacity ------------- Type --- ---------------- <br /> Line ------ <br /> Foundation --------------------- Prop --------- <br /> Distance to nearest- Well r_---t t- <br /> I I Total Length;—t--- -------- .......... <br /> -------- Length of each line-------------------` <br /> LINE No. of Lines ---------------- <br /> - A--------- ------ <br /> { �'D' Depth Filter Material ----- <br /> r--'D' Box -- ------ Type Filter Material Li6e ---------------------- <br /> t I I ------- Property <br /> Distance,to nearest.. Well ------------------------ Foundation ----------------- <br /> i I 1 .1 Rock Filled yes [3 No 0 <br /> T�rij I . Diameter ---------------- Number ---------------------------- Ro — <br /> SEEPAGE PIT Depth -------------------- A� <br /> ;­� I I Rock Size ---- --------------------------- <br /> Water Table ------- <br /> e Depth ---------------------------------------- <br /> Foundation -------------------- Prop. Line --------------L <br /> v.1 Distance-to nearest: Well ---------------------------------------- I <br /> -I t I Date ------------=---•--•--------------) <br /> REPAIR/ADDITION(Pr'ev- Sanitation Permit# ------------------------- <br /> 1� i . . — - I ------------- ----------- ----------- <br /> ­�� 0 1 ------------------------------ <br /> Septic Tank (Specify Requirements) -------------------i------------ -Z-11 <br /> Disposal"Field (Specify Requiremenq) 2y""A. <br /> --------------- --I------------- <br /> ---------------------------- <br /> ---------------m----------------Z------------------------------------------------------------------------------ --------------- <br /> -- -- --------------- --------------- <br /> -------------------------- ---- -- ---- red addition on reverse side) I <br /> j (Draw existing and required ' With Son Joaquin <br /> ;.JIN application and that the work will be done in accordance <br /> I hereby certify thatl,have prepared this <br /> k i s of the Son Joaquin Local 'Health District. Horrie owner ort <br /> Ordinances, Siate Laws, and Rules and Regulation <br /> sed agents signature certifies the following: mit is issued, I shall not employ any person in such manner <br /> performance certify that in the p�rformace of the work for which this per <br /> as to bec, e su 'ect to,W rkma -Compensat' laws of California." <br /> her <br /> Signed - --------------------------- <br /> ----------------- ---------------------------------------------- <br /> Title -- <br /> -- <br /> By ---------- ------------- -- i�c_ <br /> (if other than owner) ONLY <br /> FOR -DEPAROX ENT USE 0;;;:::::::::: <br /> DATE ----------------------- <br /> --- <br /> ------------------ <br /> APPLICATION ACCEPTED BY ---I/WA�V_ ,w----�---W04 I- - -- ----------- DATE ------------------------ ----------- -- ---------------------------------- -- ------------------------------------------------------------ <br /> BUILDING PERMIT ISSUED ------- <br /> ADDITIRA COMMENTS -----&_ <br /> -------------C-P------------------------------ --------------------------------------------- <br /> ---------------------------------------------------- <br /> _�7 ---- --------- <br /> tv-Aft--.- 6-- -6q------ <br /> (A------ --- ----------- ---------------------------------------------------------------------------------- ------ ------------------------ <br /> ------- ---- - - ------- ---- <br /> -Final Inspection- - - by-;--%-------6 ------------------ <br /> ------------------------------------------------ --- ------- Date ----- -- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M. <br />