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FOR OFFICE 0SE: <br /> APPLICATION FOIL SANITATION PERMIT <br /> t {Complete in Triplicate} Permit No: -------- <br /> ______F__ This Permit-Expires 1,Year From Date Issued Date Issued <br /> r Application is hereby made to the San JoaquinLocal Health District for a permit to construct and install the. work herein <br /> described. This application is made ih compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION T ION fL ---_ �----------•---------------CENSUS TRACT <br /> ------------- <br /> .__ _ <br /> Owner's Name Phone <br /> ------------------- ------------- _ <br /> Address /9.779-------15--------S)-F_0- Fz-�---------- -- - . City <br /> Contractor's Name ---- 1&V.t1F1E1.}, <br /> ._-�-.-- 1-------•-- ------.License ----- ------------------ <br /> Phone --------------- -------------- <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailers i�­ <br /> r:f­ , t i uc <br /> Motel ❑ Other -----f°-------------------- -�" <br /> Number of living units:____ .______ Number of bedroomsGarbage Gr0n er-_�n_ _ Lot Size <br /> r <br /> Water Supply: Public System and name ______________+--------------------- <br /> _______ _. _ Private <br /> p ❑ I --- -----•-- y � Peat,�0 �'` Sandy--------•-----------------------•- <br /> Character of soil to a depth of 3 feet: Sand' S' Clay� r 6t i ` Loam ❑ Clay Loam <br /> ;. <br /> F�ardpan_ W; Adobe ❑ Fill Material___.yr _ If yes,type ----� ': ^'""""_% <br /> (Plot plan, showing size of lot, location of system in r lotion to wells, buildings, etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank o -seepa pit permitted if public sewer is available within 200 feet] <br /> r� ff <br /> PACKAGE TREATMENT [ SEPTIC TANK'[ Size__df (1_� X '_________ Liquid Depth _f,_�_�_,13 _..__-___-_- , <br /> / : <br /> Capacity _/_: 0 _ "" Type " 'Material___ T Na' Compartments ______•. --_—.___ ` <br /> stance to nearest: Well ------- 40---- ---------..Foundation :17:___ Prop. Line ______- i <br /> LEACHING LINE No. of Li --_ ____ Len th of each line-_-_-_ ` t - i <br /> �es ------ ---:------------ 9 ...�, �`�___---- ----- Total Length .-- --------- go <br /> 'D' Bo w-___ Type Filter. Material _ ¢� .E'ZDepth Filter,Material _______ �____---f:_ <br /> Distance to nearest: Well ___ ____-_�_f Foundation __--f ___`F___ Property, Line <br /> r <br /> SEEPAGE PIT Depth � __"_.______ Diameter �____,k_X Number ____/_ Ro Filled Yes No i❑k(' <br /> j L <br /> Water Table Depth ` Rock Size v. <br /> "---- 5------------p --s--------- y� _ <br /> I { Distance to nearest: Well -- i �____^- :-----------Foundation ---_ft _'•*`;Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit c# -------- ------------- <br /> -------- Date -----------------------------_"_--) 1 <br /> Septic Tank (Speci-fV Recju,irements) t-------------------------- �� " <br /> ---------------- -----------------------------------•------------ -----'------------ ------------ <br /> `' <br /> Disposal Field (Specify, Requirements) ______________ l� <br /> 3 ------------'•------ ----------------------------- <br /> 1 I � 1�`t�t � f } ------- . <br /> ---------- -------------------------------- r i <br /> ---------------------"----------------------------------------------------.---------`----------------------------- <br /> --------- <br /> ii <br /> ------------ <br /> {Draw existing and required(,addition on reverse side) <br /> (thereby certify that I have prepared this application and that the.work wil! be dori'e in accordance with San Joaquin <br /> k Co my, Ordinances, State Laws, and Rules and Regulations of the.San Joaquin Local Health'Distrlct. Home owner or licen- <br /> i.f- <br /> sed agents sign9ture certifies the f (lowing: <br /> J "1-certify in the performance f th work for which this permit is issued, I shall not employ any person in such manner <br /> as_� o b ame subjec# to Worm mpensation laws of California." <br /> _ _______ _____ <br /> --_ _ fi , <br /> ---------------------------------„ <br /> Owner <br /> BP-------------- ---------------- --------- --------------------- ,`:, 1':Ti e ------------ -----------------------------I <br /> R-.. ---, <br /> I{ other than ownerl FGR I��PARTIVI`ENT^tUSE ONLY � ""--------- <br /> i APPLICATION ACCEPTED BY ----'7-!-k- <br /> 4-0--�------------------------------------------- ----------------------- - DATE /�r / <br /> BUILDING PERMIT ISSUED -------------h ------------------_ ( r <br /> ADDITIONAL-COMMENTS <br /> -----DATE - <br /> -- <br /> --------------------------------------- <br /> - _ t _ ._ - ._._ •- --- <br /> ------------- <br /> ----------- -- -- --------- 1` y _ `n �� r <br /> ----------------- - - - <br /> ------------------- <br /> Final fTrspe ion b - -- --' - --� -----------------•------------afie------ -----`-�- - � - � -• - <br /> -- ---- - - -- - <br /> --- ----- --------- --- - -- ----------- ----------------_--D � ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H, 9 1-'66 Rev. 5M <br />