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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �a �.]� <br /> Permit No. --".--- - <br /> (complete in Triplicate} <br /> - ---- -------------- <br /> Date Issued ��-�.'- -- <br /> _ _ This Permit Expires 1 Year From Date issued <br /> - <br /> . lication is hereby made to the San Joaquin Locwith <br /> Health District for a permit to construct and install the work herein <br /> App' <br /> ppibed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> descr <br /> _CENSUS TRACT __------------- ---------- <br /> ,�- � <br /> --------- e�� •�'� ----------- ----- L <br /> JOB ADDRESS/LOCATION�.��--- -�/,-- ---� -- - <br /> Owner's Name -.,C-.-i� _e--------- ills----------------- <br /> -- --- <br /> /�" seU 1-/ - ------------------------------. City A-t4� _/="� ------------------------------------------- <br /> Address <br /> ----------------------------------- - -- <br /> Address - 3II License #JVV1 ----- Phone 7�.3�fII- <br /> != 0, �°1-�---------- -----. . <br /> Contractor's Name --.--�-�-- --�- � - <br /> Installation will serve: Residence V Apartment House°❑ Commercial ❑Trailer Court ,❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units------------- Number of bedrooms --a------ Grinder ------------ Lot Size _I -I- .------- <br /> - - - ----------------------------------------------------------------- <br /> _Private Q�` <br /> Water Supply: Public System an name ------------ - -1 Cia Peat❑ Sandy Loam •❑ Clay Loam 11 <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Y ❑ <br /> ❑ Fill Mafierial ___----- -. if yes, type <br /> Hardpan E] Adobe <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> 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,) N1,, <br /> PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size-___-__-___----------------------- <br /> ------ ---- Liquid Depth ------ ------------ ----- <br />{ ------- Material------ ---------- - No Compartments ` <br /> Capacity -- ------------------ Type --------- <br /> _ Foundatio --- Prop. me ---------------------- <br /> Distance to nearest: Well _-__------ -------------------- <br /> ------------------- <br /> LEACHING LINE [ ] No. of Lines <br /> -- -- -- - - ------- -- Leng of each line_--------------- ---------- <br /> V <br /> - -- --- Total Length -----------�---• <br /> I -Depth Filt r Material -------------------------------------------- <br /> 'D' Bax ------- --- Type Filter Ma <br /> tedl ------------------- <br /> Property Line - <br /> Distance to nearest: Well _______ ____ ___ Foundation -.------ ------------- P <br /> SEEPAGE PIT [ ] Depth ___-------- - <br /> Diameter --------- Number --------- --------- Rock Filled Yes 0 No I❑ <br /> ------Rock Size -------------------------------- <br /> 't <br /> ------------------------ ----- <br /> Water Table Depth ---------------- ------------- <br /> Foundati n Prop. Line <br /> Distance to nearest: Well __----- ----- <br /> ----------- - <br /> • Date ----- - ---- ---------------------) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- --- <br /> ---- ------------ ------------ <br /> Septic <br /> ---------- f <br /> Septic Tank (Specify Requirements) ------------------- j <br /> - --- <br /> Disposal Field (Specify Requirements) ---"-- ------ --- -----" ------ ------ - <br /> -------------- <br /> sl'" --ire'�x------------------------------------------------------------------------------- <br /> F ------------------------------ --- ----- ----- ---- <br /> (Draw existing and required addition on reverse side) <br /> n andne in accordance <br /> ui <br /> I hereby certify that 1 have prepared this applica i ulat'sonsthat the work will be o 't <br /> of the San Joaquin Local Health DistriiDistrict. Ho eowner or Icen- <br /> County Ordinances, State Laws, and Rules and Reg <br /> sed agents signature certifies the following: person in such manner <br /> "I certify that in the performance of the work for which this permit is issued, 1 shalt not employ any <br /> as to become subiect to Workman's Compensation laws of California." <br /> k <br /> [If �----j------ -- -Si ned <br /> owner <br /> Title - <br /> BY <br /> other fihanowner) <br /> 6,011 <br /> y <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y _.--.----- -- <br /> --- -- - <br /> --- DATE ...... " 7 7-. �J----------- <br /> BUILDING PERMIT ISSUED ------------------------------------ <br /> ----- -------- ------ -----------•----- -------- ---------------DAT ------------------------------------------- <br /> BUILDING <br /> --- -- --- ------ ------ ------ -------- <br /> ADDITIONAL COMMENTS ------ ----------------------------------------------------------- <br /> ---------------------------------------- <br /> - -------------------------------------------------------------------------- <br /> -------------- <br /> ---------------- <br /> i -------- ------------------ <br /> --------------------------------------------------------------------------------------------------------------------------------- <br /> - - ------------------------ - <br /> -------------------- <br /> --Date --- --�-----`1-�� �, <br /> Final Inspection b - ----- ----------------- <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> G W 0 1-'68 Rev. 5M <br />