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V".FOR OFFICE USE: a' <br /> FOR,R.SANITATION PERMIT <br /> _- /p <br /> :: (Com-- _ <br /> life in Triplicate) Permit No.._ /_ <br /> --------------- --- -------------------------- <br /> This Permit Expires ! Year From Date Issued Date Issued .. ------------- <br /> ./ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JO8. k1DDRE55/LOCATION ----- /�J �-Z J f h�'�----- ------- ---------- CENSUS TRACT =' <br /> Owner's Name --------------------------=------------------------:--------------------- -------------Phone �� 1 �y�0-------•---- <br /> Address ------ ------------------------------------------------------ City _ / %1---------------------------------------------------------- <br /> ------.License # -7� �����.�---- <br /> Contractor's Name .__�1�'.,f-�____..S:I'f�_-__-_ _.- __ � � Phone <br /> p ❑ ❑ <br /> Installation will serve: Residence Apartment House Commercial Trailer Court i❑ <br /> Motel ❑ Other <br /> ------------------------------ <br /> Number of living units:---J------- Number of bedrooms >-_�2 -_-Garbage Grinder _ /U-__ Lot Size 1 -________________ <br /> Water Supply: Public System and name ------------------------------------------------------- --------------- -----------------------------------Private.E!J <br /> va <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam;❑� <br /> Hardpan ❑ Adobe JZ Fill Material ____________ If yes,type --------------------------- r' <br /> (Plot plan, 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 pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' ] Size------------------------- ---------------------- Liquid' Depth -----'--------_..__. <br /> Capacity --- Type -------------------- Material---------------------- No. Compartments -------------- --- <br /> Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------------------ 6 <br /> - <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------------- --_ Total Length ___.-.__ <br /> _ J <br /> i 'D' Box ------------ Type Filter Material --------------------Depth Filter Material _-._---------------------------------------- Q <br /> Distance to nearest: Well -------- --------------- Foundation ______________ Property Line. ------------------- <br /> SEEPAGE <br /> ___-___- .-.__.SEEPAGE PIT ] Depth --------------*--_ Diameter ---------------- Number -__-.____ ----------------- Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ---------------------------------------=--------Rock Size ----------------------------- - <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------:-: <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------- -- _____________________ Date ---------------------------------- <br /> S, <br /> _-__-_---__-__________________-__ <br /> Septic Tank [Specify Requirements) ------�r - - ------� �G --f/t -_,.��---. � f /��,��_ ��.----� <br /> Disposal Field (Specify Requirements) -------- ----- --------------------------- <br /> -- ---- --- - - <br /> tin <br /> - '_re_ ----re- ---a -- - ------------- -- --- -sid--------------------------------------------------------------- <br /> [Draw exisg and requird addition on reverse e) <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 Iicen-? <br /> sed agents signature certifies the following: ; <br /> "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -- - ---------------- ------- - - -----------.------ -- ------------------------------------- Owner r <br /> By---+ --------------- ---t------ - ---- ---- - ---------------------------------. Title .-------------------------------------------------------------------- <br /> other a owner) <br /> l <br /> R- ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ . DATE - `�¢' % 4 <br /> ------------------------------------------------------ <br /> --------------------- <br /> BUILDINGPERMIT ISSUED --------- - ---- --- ---- ---- - - -------- ------------------------------ ---------------------------DATE --- --------------------------------------- <br /> ADDITIONAL COMMENTS = <br /> ----- -- - ------------------------------- <br /> -- --------------------------------------- --------- - -- ----------------------------------------------------------------------------------------------------------------------- '-------- <br /> - - ------- --- - -- ----------- ---------------- ------- -- - -- - - -- - - - ---- -------------- ---- ----- -- /- ------------------- <br /> FinalInspection by: -- -- -------- ----- - ------------------------------------------------------------------------.Date' /-.--------- --------- <br /> SA JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 v. 5M• <br />