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FOR a'S I USE- APPLICATION FOR SANITATION PERMIT <br /> ........ <br /> ..........e-.-----------•----------•------- <br /> * ` {Complete in Ydplicateli '*;. r. Per"reit No: ::7.............. <br /> f .................................a........................ <br /> _ <br /> ......----.•............................................. This Permit Expires I Year from Dat*Issued <br /> Date Issued ..�`. <br /> " Application is hereby made to the San Joaquin Local Health'District for a permit to construct and install the work herein <br /> t ,.described. This application is made in compliance witk-County Ordinance No. 549 and existing Rules and Regulations: ' <br /> ' 10B ADDRESS/LOCATION ---�I � .. f� ..(........... . ...... CENSUS TRACT <br /> .......................... <br /> €"�Owner's Name .... . ....... ... ....... ...... ..•. ... <br /> Phone�47 7.1 X.Rl ' <br /> ! Address ...... .' G4-r►�iCC._..------------`—r-;" ........................t.t . ----...City .............. '. <br /> ,cam, <br /> Contractor's Name .- _-. 5: _/1� L"` ........... # K 7 �. <br /> ..r <br /> mS•� g Phane`' F <br /> _installation will. serve: "---=Residence J Apartment Houseo Commercial ❑Trailer Court 0 <br /> Motel❑Other � ' ' t <br /> Number of living units:-.--(------- Number of bedrooms _.__.__Garbage Grinder :f11Gi.. Lot size .............'... <br /> �,Water Supply: Public System and name ..................................................... JX <br /> Character of soil too depth of 3 feet: -Sand w Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ <br /> Hardpan Q Adobe Fill Material ............ if yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pl: cod 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-- ; ] S'ae... .................. Liquid Depth <br /> ... ............... . <br /> Ca aci � 6___,,._.. ty4. ���C..... No. Compartments _.: �.... ..{/� <br /> Distance to nearest: Well y4 .. •--•-f Mater€.a..Foundation ...1.��t . Prop. Line 44rt. I dq <br /> LEACHING LINE [ J No. of lines .........:.........._-_ length of each line.--.___•................__._ Total Length ...................:..... ..� <br /> 'D' Box ----------- Type filter'Material <br /> ................Depth Filter Material ............................. <br /> ....................................... <br /> Distance to nearest: Well ------------------------ Foundation ......................... Property Line. ..............:...... .., <br /> SEEPAGE PIT [ ] Depth -------------- Diameter ................. Number ...................::....... Rock Filled' Yes ❑ No <br /> Water <br /> Distance of nearest. Well '---=----------- - =------ ::.Rock Size ....-----:..............---••--- <br /> Depth <br /> f --_........foundation ..... Prop Line ............... . ..� <br /> REPAlR/ DITION Iiev. Sanitation Permit# ............................... ............:Date .-----_-------_. <br /> Septic Tank(Spec y Requirements) .-..-------- = -------•---------- . •. ..... ......::.. <br /> Disposal F€eid S eco Re u�rement <br /> p I p fY,; q sl `T Q.. - '�.._. ..---...! T - --J--L4A �� 1 . . ..f <br /> ------------------ .....__ - <br /> V { raw existing dnd regd addition on reverse side► Y <br /> I hereby certify that I have prepared this application and that the.work will ,be done in accordance with Sae, Joaquin <br /> County Ordinances, State Laws, and Rules and;Regulations of the 'San Joaquin Local 1144alth4 District:Home owner or Ilan. <br /> sed.agents signature certifies the followings t <br /> "I certify that In the performance of the work.for"which this permit is issued; ! shall not employ any persbn.in such manner <br /> as to become subject to Workrnan's'Compensation laws of California." <br /> . <br /> t Sr ned ---.--------------- <br /> -------------------------------- -----------------------­--- ------------ Owner i <br /> Ji -------------------------------------- <br /> BY ---- '-----=------------- tle - :_C. ►. .ct.. <br /> (If. <br /> other than owner! l <br /> R DE ARTMENT USE ONLY <br /> I'APPLICATION ACCEPTED BY <br /> .-- -- ------------------ =-t .:._. ATE ............. = <br /> BUILDING PEttMiT ISSIJI=D;d'.. --- ----- -- -------- <br /> ADDITIONAL C6MMENTS .................... - ------ = <br /> I ------------------------•----•--------------------------- <br /> ------------------------------------------------ --------------------------- <br /> ---------- <br /> ----•--•----------------•------------ ......_..-- .................................... ------..--------------- .._..•-•--..........---•--------- <br /> ------------------------------------------- - .... ------ <br /> Fina Inspection by: - - - ---------------------------------------------------•--------.Date .�/ .,7�..- <br /> ' EH 13 2h 1-68 llev• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br /> 1 <br /> 1 <br />