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e FORIOFFICE USE, 44 <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------_------------ Permit No.. Ze=5�M <br /> (Complete in Triplicate) <br /> ---------------------------------------------- <br /> Date Issued _6_7W7&i <br /> --------------------------------------------------------- This Permit Expires-,.l Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Heal tk'Dfstrict for a permit to construct and install the work herein <br /> described. This application is made in compliance with C.66nty Ordinance No. 549 and existing Rules and Regulations! ? <br /> f37 ! <br /> B ADDRESS/LOCATIqN -- -------- -YE P, j <br /> C C/ R.Y_�------ ---- --------- ­ -CENSUS TRACT ------- <br /> -----------------V_ -------- -------------- <br /> - ---------------------- <br /> Owner's Name ......._L/A as --------------- --------- ---Phone <br /> --------- API� <br /> 22 1 <br /> ----------------------- <br /> Address ..... -----------RPL---- - <br /> ---------- --------------- City _Aicp nc- <br /> �s ----------- --------­- <br /> Contractor's Name 1W_ _N'r=.9------------------------------------ --------------------------------License # ---------- - ---------- Phone ------------------------------ <br /> Installation will serve: Residence E]Apc�rtment,House,E] Commercial :E]Trai ler Gsw4 :[jj­ <br /> V-) <br /> Motel F-1 Oth' r ----------------------------------- <br /> ­ <br /> Number of living u'nits,.--I---- - Number of beclrooms-'__- _Garbage-Gfinder Lot Size --------------------- <br /> Water Supply: Public System and name ----9_1V__ Private <br /> -----5-ef--- <br /> h— I <br /> Character of soil to a depth of 3 feet: Sand �esil Clay E] Redt E] Sandy Loam -E] Cla -.Loam El <br /> rf C] V <br /> Hardpan E] Adobe El Fill Material ----- ------ If yes, type ------------ ---------- <br /> (Plot plan, showing size of lot, location of system iin relation to wells, buildings, etc. must be plcfce'd on reverse si <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 2�O feet,) <br /> PACKAGE TREATMENT SEPTIC TANK'[ X S7- ------ <br /> Size----- ___ �------------------- Liquid Depth __3//� - - <br /> 4'Cdpacity ------50ft-.-:-,Type P73-------:------- MateriaICIONC-------- No. Comp6rtrr'6nts --- --- ....... <br /> Distance to nearest: --- <br /> ------- -- --------------------Foundation ------- --------- Prop., Line --- <br /> LEACHING LINE -N;. of Lines ------ ----- Length' of each line'__-_ -- ------ Total Length­__/4? ------- <br /> 'D' Box Type Filter <br /> er Material'-RO (--K,_�Depth Filter Material -------- ----------- ---------- <br /> --- ----- --- <br /> Distanc�e'.fo near6't: Well ---4-------------- - n --------------- Property Line --- <br /> ,Foundatio <br /> SEEPAGE PIT Depth --------------- Diameter ------------------ Number ---- -------------------- Rock Filled 'Yes E] No C1 <br /> Water Table Depth -------- ---------------------------------------Rock Size -------------------------------- <br /> 7 <br /> ------ ------------OF"oundiPo .Li <br /> aton -------------------- ro .. ne ------ <br /> Distance to nearest:-V�eil ------ ------ ------ - 7 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --- ---------- ----------------------- D6te ------------------------------------ <br /> Septic Tank (Specify. Requirements) -------- ---- ___A------------------- ------------------------------------------- ----------------------------- -------------------------- <br /> Disposal Field (Specify Reclutirements) ----------------- -------------------------------------------- <br /> ---------------- -.7--------------------I-------------- <br /> ---------- ---- -------------------------------- --------------------- <br /> -- --------------------------------------- --------------------------------,:i----- ------------------------------------ <br /> d <br /> ----------' -`---------------------------------- <br /> -------------------------------------------------- ----------- ------------------J I----- <br /> ----------------- ------------------------------------------------ <br /> ,,---(Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this.application and that the work will be done in accordance with San. Joaquin <br /> , <br /> County Ordinances,.State-Lows, and Rules andRegul'a`fiions of the Son Joaquin Local Health District. Home owner C ir licen- <br /> r. <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 anv:,person in siiJkh-manner <br /> as to becom)vsublect to Workman's C!"ensation laws of California." <br /> Signed ------� —---------------------- Owner <br /> By ---------- Title -------------------------------------------- -- -------------- <br /> - ----------------- -------------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------------------------------- ------------------------------- DAT EA4 ------------ <br /> --— - ---------------------------------- ------- <br /> BUILDING'PERMIT--ISSUED­_-_—--—------------- --------------------------------- - -- ------- --DATE <br /> -------------------------- ----------------------------- <br /> ADDITIONAL COMMENTS ---------MOT. -F---------��Ht9jej_C_ --------- <br /> -- - ---- - ---------- <br /> ------------------------------------ ------ ----------- ---- --- ---- --------- —------------ ------------------------ <br /> ----------------------------------------------------------- <br /> -------------------------------------------------------Ddte ---- ----------------- <br /> - ----------- <br /> --------------------------------- ---- -- ---------- <br /> ----- ------------------ ---------- -- ----- --- -- ------- -- ------------------------- <br /> - ------------ -/ <br /> ----------------------------------------------- <br /> Final Insp ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />