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FOkrOFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> _.S;so war � (Complete in Triplicate} Permit No: _.7__L _�_�� <br /> - ---------- i <br /> ----------------------------------------- --------------- This Permit ERpires 1 Year From Date Issued <br /> --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/LOC ION -------- ---------- <br /> C5 h h 0--r-------------- - ------ ----CENSUS TRACT -------------------------- <br /> Owner's Name ---------- -I' -V,- e---------- ( � _ <br /> -------------- --------- ------ Phone <br /> Address. - L_I-�--------------------------•--. City G 7�' ---------------------------- ---------------- <br /> Contractor's Name p.�°-------Z°a` License #��.4_.aL Phone - �s- /se <br /> -- ----------------- <br /> Installation will serve: Residence B-Kpartment House❑ Commercial []Trailer Court ❑ <br /> Motel ❑Other ------ <br /> 16. <br /> yr. �� � / <br /> Number of living units Number Number of bedrooms _______Garbage Grinder �j�.5.___ Lot Size __-�_-__�._�_______________ <br /> Water Supply: Public System and name ----------------------------- ------------------------------------------------• ----------------------------------Private <br /> Character of soil to a depth of 3 feet. Sand'❑ Sift❑, Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑s-t Adobe- ill Material /.1/p___ If yes, type ___-__-_____________________ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) d <br /> NEW INSTALLATION: (No septic tank or seepa �t#permitted if public sewer is available within 200 feet,) � <br /> PACKAGE TREATMENT <br /> [ ] SEPTIC TANK;W i Size--- '�Y'�`!Y`�--------------------- Liquid Depth ---T-,���------------ k0 , <br /> Capacity ---------�Type MaterialNo. Compartments --------------- <br /> ance to nearest: Well -------_1---------------------Foundation --------------- Prop. Line ---------_--- <br /> LEACHING LINE No. of Lines �y <br /> [ ---�-- '-=--'------- Length of each line--�-f/--��---�------ Total Length ............... <br /> 'D' Box _L( ___ Type-Filter Mgterial Nl�__ _________Depth Filter Material _ �C�_r--_____________________./_- <br /> 1 <br /> Distance to nearest: kVell -----.P..._......... Foundation -----Iq__/---------- Property Line -S___--_________ f <br /> SEEPAGE PIT [ Depth u -------------- Diameters< 3--------- Number _ _.._--�------_ Rock Filled Yes No <br /> Water Table Depth _---- <br /> T----------j-------- <br /> .._ Rock Size __ --'---------1�-------------- <br /> Distance to nearest: Well _.___ /4_ d ___Foundation _-_- ; <br /> ,F-"- -------•----------------- ----f�------- -; Prop. Line .,��---•----•- � <br /> REPAIR/ADDITION(Prev. Sanitation Permit'# ---------._.____�.__-___________________ Date ________________________________�_} y <br /> Septic Tank (Specify Requirements) -------- { r_1._'"=- ----------------------------------- -------------------------------------------- ------ ' <br /> Disposal Field (Specify Requirements} ----------r"':"';._-. ___. <br /> I <br /> -------- ----------------------------------------- '` - <br /> t -------------- <br /> i Ir <br /> (Draw existing pnd required addition on reverse side) <br /> I hereby certify that I have prepared this applicgtion-and.--th_at the--wor _will:be done•-iin, accordance with�San Joaquin � <br /> County Ordinances, State Laws, and Rules and Regulations of the Sari Joaquin Local Health•bistricF.Home,owner or licen- <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 any persona in such manner <br /> -- laws of California." <br /> as to Signed ---. ------- y - i5�. a :� :•f,. t <br /> become subject to or man ; Compensation <br /> g ----1 ��- --------------------- --- Owner <br /> B --------- 'Title w �1_ » =-------------= <br /> Y -=--------------------------------------- --- ----------- <br /> (If other than o er) _.._ __. <br /> FOR DEPARTMENT USE ONLY <br /> .. 5 <br /> ---- <br /> APPLICATION ACCEPTED BY ------ --- - DATE ' S <br /> - -- -------- --------------------- <br /> BUILDING PERMIT ISSUED ------------------ ----------------------------------------------------- ---- ---------------------------DATE <br /> ADDITIONAL COMMENTS ____________________ i ' <br /> i - - - -�-P ---------- ---- - --- ----- -- ------- ---- ` __ - --- -Y?-- <br /> Q�' _ _ <br /> ------- -------------- --- ---- ------ <br /> Final Inspection by: ---------------------------------------Date -------�----5~j_ ''------------ t <br /> ef <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT } <br /> E. H. 91 '68 Rev. 5M C,0-� <br />