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•� FOR OFFICE USE: , 4- <br /> APPLICATION FO.RN�SANITAfION PERMIT,f... t <br /> Permit No. <br /> �., l/ (Complete in Triplicate) 1 <br /> --- ----------------- ---- -- Date Issued ------ <br /> k --- -------------------------------------- ------------ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the ISon Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made.in compliance with Country Ordinance No. )54/9 and existing Rul <br /> es <br /> and Regulations: <br /> lr t �1)-- iJlh ' � ENS STRACTe--•----------- •--------- <br /> I JOB ADDRESS/LOCATION +t-- - �- - --- - O ; <br />( <br /> Owner's Name + �f -------- 4 Phone <br /> r�,S7Y orf�_. 115e Ae 4r4 -- _ ------/ Cir C'?y'E----------------------------------------------- <br />° Address ----- ---- �----- -- - - ------ --- Y ---- ---- -- - <br /> / -------------License # ----F ----------- <br /> Contractor's Name - Phone ------------------- <br /> Installation will serve: Residence �rtment.House'❑.Commercial ❑Traifer Court ',❑, If, <br /> r rr <br /> Motel ❑Other _ - n <br /> k f <br /> Number of livi� rng units:_-_______�N tuber of Brooms y Garbage Grinder - ---- -- Lot Size _ _ X_/. --'__�_rr -___.._._ <br /> Water Supply: Public System and name �_-- ----- <br /> - ------------------ - - Private ❑ <br /> Character of soil to a depth of 3 feet: Sand' Silt /Clay Peat Sand Loam Clay Loam <br /> p ❑ ❑ ; ' Y ❑� - ❑ Y ❑ v ❑ -� <br /> E <br /> N Hardpan E] Adobe Fill Material ---&D--- If yes, type ___-____ O <br /> ------------------- <br /> (Plot plan, showing size of lot, location `of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if pu sewer is available within 200 feet,) <br /> k PACKAGE TREATMENT [ ] SEPTIC TANK I Size_'-- { ------------ Liquid Depth f------------------ <br /> Capacity "4- 910 ------= Type CL- -- Material at _ No. Compartments ------"----------:---. <br /> I Distancelto nearest:,/Well ------ '^"' Foundation _-_ -P- /--------- Prop. Line ___/______________ <br /> ------------------- - <br /> LEACHING LINE X '7--No. of Lines -_-- ----------- Length of each line--- _ �-- ------ Total Length ________ <br /> 'D' Box Ty_ipe,.Filter Material --A—L- i._____Depth Filter Material --1-S------------------------------------- <br /> I <br /> IDistance to nearest: Well _____�~______ -_- Foundation ___f__a__�___._.---- Property Llne �__________________ <br /> S E PIT C Depth ___1- .�_________ Di4vaeter �X -- _ Number ---------�v---------- Rock Filled Yes C ` No ❑ <br /> I Su,-Wy ,Water Table Depth ----- -- 0-;----------------- Rock Size __�-�2�X --------------- <br /> t i -_ <br /> WS <br /> ,Distance to nearest: Well ---------: ----------------------Foundation ---- -------- Prop. Line _. ---_------ -_-• <br /> I P <br /> REPAIR/ADDITION(Prev. Sanitation Permit-W" ------------------------------------------ Date ---------------------------------- <br /> I ----�---------- <br /> Septic Tank (Specify Requirements) =-------- ------------------- ----------------------------------- - ------------------ ------- ------------------• <br /> DisposalField (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------•----------- <br /> F --- <br /> --------------------------- --------------------- � k -------------------------------------- -- ---------------------------------------------------------------------------- <br /> i (Draw existing and required addition on reverse side) e <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San �oaquin <br /> County Ordinances, State Laws,lkand Rules' 'and Reg6lations of the San Joaquin Local Health District. Home'owner'ar licen- <br /> sed agents signature certifies the following: 1 <br /> "I certify that in the performancelof 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 low's of'California." <br /> Signed --------- --------- ) <br /> -- ----------- ------------- ----f------------------------------- Owner J � <br /> BY 1 4 = ..3 t!e --- <br /> Ti <br /> k (If other n owner) �'a f.s <br /> 4e FOR,=DEPARTMENT USE ONLY <br /> i <br /> APPLICATION ACCEPTED BY ......................."-"--------- -----------------------------------------' ----------_. DATE --- -- -- .B T ------------ <br /> BUILDING PERMIT ISSUED °----------- - ' i . __. -- :-------- <br /> ------- w v_a,. -- ---DATE_ ,-�--_-»------------ - <br /> ADDITIONALCOMMENTS ---- - 0 -----•9 -----------------4------------------------------------------------------------ ---------------------------------- <br /> --------------------- <br /> -—-- .--- ------ <br /> Erl ; --------------------------- ------ <br /> i .� i--------------------------------------------------------------------- -8 <br /> ------- -- -------- l - <br /> Final Inspection by: --- - -- - ------------------------------i -----------Date ----- - 1 -"�----J <br /> L-- ------------- '- <br /> ° SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />