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FOR OFFICE USE.- APPLICATION FOR SANITATION PERMIT <br /> ....................... <br /> ... -- . (Complete in Triplicate) Permit No. . ............. <br /> 1 � _ ' Date Issued ...5: .- .. <br /> This Permit Expires 1-Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> p <br /> Jas ADDRESS/LOCATION ........- ��- :5p...... <br /> ...... ...................CENSUS TRACT ..._....__..... .......... <br /> Owner's Name ..................... <br /> <? ._LM`.7`4N......�?4-kC.y-------------•-- --.......---..............--...........-..Phone -4.46_— 11.9-.7 <br /> 1 <br /> Address ..----------- ...........................ftl+t-E--•----------- -----......--•---..._.-.--•....... City -----•--....-_....1............................I.......................... <br /> .. <br /> j ,Q , <br /> Contractor's Name .------.....�:.1¢� ...................License ..... Phone .: 6-?—¢.c�.T..... <br /> Installation will serve: Residence ((Apartment House[] Commercial []Trader Court ❑ <br /> Motel ❑Other ........ <br /> Number of living units Number Number of bedrooms �y-----Garbage Grinder <br /> ............ lot Size ._ - X..._ !�1 -14 <br /> Water Supply: Publit System and Iname .------ ---•--... ............ •----.------.--•-•----••--...... -------------- I..............................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C] Clay Loam ❑ <br /> Hardpan ❑ Adobe �$[ Fill Mate�� l .-• •-- j estype ................ <br /> a <br /> {Plot plan, showing size of lot,_,location of„system_In relation to wells, buildingC—AcIrmust be placed on reverse side.) \ <br /> NEW INSTALLATION: (No septic tank o seepage pit permitted if publicsewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ ];AA1;� Size----------- --- ... Liquid Depth ......._. <br /> ...- ... ................. <br /> Capacity; ` Type Material.............. No. Compartments ` <br /> --------- T e .-••---•--• <br /> Distance oto nearest: Well _•_______________•--_----•---------Foundation-.......------------- Prop. Line ...................... <br /> 1 1. ti r <br /> LEACHING LINT: [ ] No. of Lines ------------------------ Length of each line..___-----_.--:........�... Total Length <br /> _.......... ................7�L <br /> 'D' Box .t.......... Type Filter Material ____________________Depth Filter Material .................----....................... <br /> Distance to nearest: Well ........................ Foundation ............._ ...I-.-___ Property Line .................... <br /> SEEPAGE PIT [ j Depth ...1............... Diameter .....____.. .... Number ...................... ----- Rock Filled Yes ❑ No ❑ <br /> • Water Table De th .....Rock Size <br /> L <br /> ------- --- <br /> Distance 10 nearest: Well -----•....................Foundation ----- .............. Prop. line .... ................. <br /> rev. Sanitation Permit# __._�------------------- ................ Date ...........-------- ............... <br /> Septic Tank (Specify Requirements) .................. .. . .... : ---------------------- ------------------ ....................................---------------- <br /> Disposal Field (Specify Requirements) ....... - ..t--------...-............. <br /> ............-...... <br /> ................. <br /> ......................................................I-- - ............. <br /> 3 :r- ... '-_. ---------••- <br /> � <br /> ------------------------------- ----------------•-.--' - ----"....--------------------------- -------. -...._....---f""`="'?-------:--------- ---------•----------•------•--................--.------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that tha work will be1done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations*of the San Joaquin Local•H_ ealth District. Home owner or licen- <br /> sed agents signature certifies the following: I <br /> "I 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 laws of California." ' <br /> Signed .. t` ,Mc.Owner <br /> By ..................... ... ............ .... ...... . ... -------•--•---•-•----------------­- Title -&?%n..--I.................................................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ......!. ....... .. . .. ...... ..................................•-............................L DATE . .....�............ <br /> BUILDING PERMIT ISSUED ....... .!...11.. .. .......... .. ,( ' DATE _.........................-----••---------- <br /> ADDITIONAL COMMENTS -.-.-.a 5.T_ . ..- �.V----l_? ------------------------_.;...... _... ..........................-•------ <br /> •------------------- --------•--...-._:....... --------•------------------ ........................................................................... ........ ---...----••---------••-----•-------......----.-----------•---•- .................................................... <br /> •................................•---------- ---- -- <br /> ,. <br /> Final Inspection by: ............. G% -----I....... ............. § Date .... -..... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M 7/ 1 K <br />