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� vi'•nu uoc: ---T = <br /> APPLICATION FOR SANITATION PERMIT <br /> .... ............................_....._...r�...... <br /> (CetntpietelnTriplicate) i Permit No. ..7..6.�.7�e <br /> This Permit Expires t Year From Date Issued Date Issued ..h.�'3.7.. <br /> ti <br /> Application is hereby made to the San Joaquin Local Health District for a permit to const►uit and Install the work herein <br /> described. This lication is made in compliance with County Ordinance No: 549 and existing Rules and Regulations <br /> g - , <br /> JOB ADDRESSAOCATI ' <br /> . .. .-....... ...... <br /> ....... <br /> '``.........................GENSLIS TRACT....................................................... <br /> Owner's Name .. Phone <br /> Address ....................... . ... . . <br /> C� ..-•............................City ... ._ ................................... ... <br /> . .. <br /> Contractor's Name .. . .: .... ....................................................License .� ,�! . Phone VAX <br /> installation will serves Residenceo`Apartment_Housed Commercial❑TrallerCourt <br /> F Motel (I Other............................................ r , <br /> i <br /> Number of liv)ng units.... Number of bedrooms Garbage Grinder Lot Size ........7C---' <br /> Water Supply: Public System and name ----•---•----•...............»_..--------.._.....----...............----....................._------...Private' <br /> Character of soil to a depth of 3 feet: Sand Silt❑ 'Clay 0 Peat❑ Sandy Loom ❑ Clay Loam <br /> Hardpan❑ Adobe W Fill-Materlol . .........rif yes type.............. ............ <br /> !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an 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(tr' Size.:y!� �.�.I.................... Liquid Depth _10/......._.._...... <br /> Capacity 4R.L?.4_... Type 60,C_.�-W. Material...._`..... No. Compartments ...Z:.......... <br /> Distance to nearest: Weil �� __.Foundation ..1.Q._...... <br /> - __.... --••---...._._.._ .. ....... Prop. Line ....?�.............. <br /> _EACHING LINE ['' No. of Lines ......!............. Length of each line..: �.. s�.... Total Length ��1 �...---•-• <br /> 'D' Box .../....... Type Filter Material .=!. d Depth Filter Material ....../S.............................. � <br /> Distance to neareFts Well ./...;.4z........... Foundation .. .d.�:..... Property Line ........................ <br /> SEEPAGE PIT )y" DepthT q� ji <br /> ---�5........ Diameter -..�r�.:...... .Number. .......... .... ..�. . . Rock Filled Yes �'' No �] <br /> Water Table Depth ...... .,fd ...... .. .................Rock Size ..c z?.�. i <br /> Distance to nearest: Well .-•--.,� t1.. ..................Foundation ..`....... Prop. Line �............. <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ...................................) <br /> SepticTank (Specify Requirements) ........................................... ................................................................. ..........._................. 1 <br /> DisnosalField (Specify Requirements) --•..............................••-•------•---•----...-•----..................----.................................................. : <br /> ............................................................................................................:......................................................... ............. <br /> ••----.------•..........................••--...--.........__.....--------.......•••...........----••--------------.._._............................ ...........................................{Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work wifl 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 /> "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 bee ublee! ton's- Compensation laws of California." <br /> }aJnec' - -� ...... . Owner <br /> .---::: 3111e .... -......_ .{ <br /> ay .......... ..:......................... ..... <br /> ... ..:............. <br /> •' '_(If other than owner) <br /> FOR DEOA.RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ........ :. .............................................................. DATE ...... ...7 6.........::: I <br /> BUILDINGPERMIT ISSUED ...::_............. . --_...........................-----.................................I..............DATE........................................... # <br /> ADDITIONAL COMMENTS .................°.............--............_.I.....-- _-...-.................. <br /> ----........ ------------------ -----------------------------------------•----------.----.-- ------.- ....-....--- .. ......... ......-- ..........I—— <br /> .........-- • ........... .............. .. <br /> `�.. �; <br /> Final Inspection by: ---.. . -- - .. .. .....I........................... ..........Date ......... . ..� <br /> EH <br /> 13 2!i 1-68 H°v' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> C <br />