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�-FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------ --- ---- ---------------------------- -------- <br /> -.Complete in Triplic'a—te) Perm itNo-72- <br /> Date Issued y___3.�-:1­v- <br /> --_------------_---------------_-_---______----.__-- " <br /> 7 This Permit Expires 1 Year from 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 /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------------- ---- ----------1-'--------`-r---- - ---- - --- ---- ----- ---------------- CENSUS TRACT ------ <br /> Owner's Name --------- &-- ------ --------------------------------------------------------------------------Phone ------------------------------------ <br /> Address ----------------j 61 ol <br /> ------ ------------------------------------I------------­. City 5!n_rA%-a-4.r------------------------------------------------ <br /> ------- ---------------- Phone --------------------------- <br /> Contractor's Name - ------ ---------------------------------------------------------------License # <br /> Installation will serve: ResideAce E] Apartment House,U Commercial []Trailer Court [I <br /> _Motel Cher - <br /> ------------------- <br /> b <br /> Number of living units:---- ------ Number of*bedroms A/-------Garbage Gryder Lot Size ----- --------------------- <br /> Water Supply. Public System and name --------------- Private E] <br /> ------------------------------------------------ <br /> al Si <br /> Character of soil to a depth of 3 feet: Sand' Silt 3- Clay-E]- Peat C -Sandy-Loam -E] Clay Loam E] <br /> Hardpan Ej Adobe E] Fill Material ------------ If yes, type________________'__________ <br /> F <br /> (Plot <br /> ype,---------------------------- <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 public sewer is available within 200 feet,) <br /> ;e —0e .0 <br /> size --,YX,6. �K Y16> Depth PACKAGE TREATMENT [ V)SEPTIC TANKX ----------------------- ------ Liquid th ----------—----- <br /> Capacity J ------- Type 101"-4J*------ Material No. Compartrobnts ------t-------- -•-- C) <br /> Distance to nearest: Well __ ____`'—_____________________Foundation A____.___ Prop. Line ----I--/---------- <br /> LEACHING LINEes -------i-------------- -Length of each line------ ----------- To'tal Lehgth` <br /> No. of Lin �;r-------- <br /> 'D' Box _gip--- Type Filter Aoterialllw�_Depth Filter Material ------10------------------------------ <br /> Distance to nearest. Well <br /> _____f------------------ Foundation ------------------ Property Line <br /> ------------- <br /> SEEPAGE PIT Depth I____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No C] <br /> Water Table-Depth ---------------1------- -----------R-9r1k Size--------------------------------- <br /> Distance to pearest. Well ------------------------ ..........Foundation -------------------- Prop. Line ---------------------- <br /> REPAIR/ADDITION(Prev, Sanitation'Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic Tank (Specify Requirements)7_:___i__,. --------------- --------------------------------------------------------------------- --------------------------- <br /> Disposal Field (Specify Require�merN) ----------- --------------------- ------------------------------------------------------------------------------------------------- <br /> --------------------------------------------------A------------------------------- -- <br /> ------------------ - - ------------------------------------------------------------------------I------------------------ <br /> --------------------------------------------------------------------------------- -- -------------- ---- <br /> (Draw existingan required a --------------------------------------------------------------------------------------------- <br /> dclition on reverse side) <br /> l <br /> I hereby certify that I have prepared this application and that, the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of,the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the erforman of the work for which this permit is issued, I -shall not employ any person in such manner <br /> as to become sub' to W a enscitionVof California." <br /> Signed ..... -----Owner <br /> By ---- - ------------------------------------------------•------------------------------------------------------------------------------------------------- Title -- ----------1--- ------------------------------------------------------ <br /> (if other than owner) <br /> F9f EPARTMENT USE ONLY <br /> !q 62 _9 <br /> APPLICATION ACCEPTED BY --------- ----------------- --------------------------------�__DAiE ------ --------------------------------- <br /> BVILDING PERMIT ISSUED <br /> -- ------------- ---------- <br /> ---- ----- - ------- --------------- --------- DATE ---------- <br /> ALDITIONAL C9MMENTS tro;td _.- <br /> 0 ,0, CA=__ - __ --- --------------- <br /> ----------------- - --------A. --------------- <br /> -------------- <br /> ----------------------- <br /> ----------- ---------------------------------Y-------------------------------- <br /> Z,5&_-Z— ------------------------------------------------------------------------------------Date <br /> ------------ <br /> Finaiinspection by: !P ---—--------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />