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FOR OFFICE USE� <br /> APPLICATION'FOR SANITATION PERMIT <br /> ----------------- Permit No. = 9�7 6 <br /> (Complete inTriliilicafe) <br /> ---------I- -------------------------------------------- Date issued <br /> --------------------- ----------------------------------- 41-�Ihis Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit to-construct and Install the work herein- <br /> described. This application is made in compliant with County Ordinance No. 549 and existing R 'Ies and Regulations. <br /> ------------- ----CFNSU� TRACT <br /> JOB ADDRESS/LOC �.ON 7 --------------------------- <br /> - ----------- hone <br /> --------- <br /> ----------------------- <br /> ----- <br /> d----------------------------------------- <br /> Owner's Name ----- <br /> Address <br /> _-a�--------------------------------- ------ City <br /> ---------•---------.License #r,�_ Vlqq----- Phone <br /> Contractor's Name ... - ----- -- <br /> Installation will serve: ResidenceXApartment House-E] Comme'rcial :oTrailer Court 0 <br /> Motel F-l Other ------------------------------------------ <br /> �L <br /> Number of living units:--__ -_ Number of Jqedrogms 'r— <br /> ___Garbage Grinder ------------ Lot Size ---------------- <br /> Water Supply. Public System and name ---- --------W_J_59k------------------------------------------ -1----------------Private El <br /> Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay .[] Peat 0 Sandy loarn'F!E]-` Clay Loam E] <br /> Hardpan E] Adobe)< Fill Material ----------- if-�l- --- ----------`------------------ <br /> ! L a � � <br /> (Plot <br /> --------- ----------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,`eic.' rri­u�rti%lbe"placed on reverse side.) <br /> NEW INSTALLATION:i (No septic tank or seepage pit permitted if public sewer`is available within 200 feet,) <br /> -------- -----------f Liquid, Depth ---------------- ------- <br /> - - V -_ \k <br /> PACKAGE TREATMENT' SEPTIC TANK Size--,?XS X(i_'--- <br /> Capacity ,0d------ Type oet"41-- Material No. Compartments ---- ....... <br /> Distance to nearest: Well <br /> - ----- - -- <br /> ---- -- ----------Foundation -------------- .. .. <br /> Prop. Line .. .. . . <br /> _ - ' <br /> BLEACHING L-1 I NE No. of Lines ------/----------- Length of each line---- ---�_F ----------- Total Length ------- <br /> D' Box ------- Type Filter M <br /> - <br /> Depth-,Filter M ��_42------------- <br /> ------ citericil's-,_ Material ---- --------------- <br /> Foundation -0------------ Property Line ------ <br /> Distance to�qqarest: Well --- 7 <br /> SEEPAGE PIT 'Depthl;07- ter Number k Filled Yes)R' No 0 <br /> �2p't-__ Diameter lvi2----- <br /> e ------------I-----------------R1 ------ <br /> �A`Water Tab <br /> ---- - ---- --- -------- Fou�dalflon -------- 'Prop. <br /> Distahce tic) nearest. Well ------ Line <br /> ;0 <br /> REPAIR/ADDITION(Prev. Sanitation Permit <br /> ------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) -----------Ii <br /> ------ <br /> -------------------------------------------- ---------------------- <br /> Disposal Field (Specify Requirements) --- -----------------------------------�_A----- -------------------------------------------------------------------------------- <br /> ------------------------------------------------------ --------------------------------------------------------------- ------ --------I----------- ---------------------------I- <br /> ----------------------- <br /> ----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> [Draw existing and required addition on reverse'-�side) <br /> � "'r <br /> I hereby certify that I have prepared this application and that the work will be done in' aicoMcince 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: 't I <br /> i. "I certify that in the performance of the work for which this permit is issued, I shall not employ any persoh,en such manner <br /> as to become subject to Wo kman's Compensation laws of California." ;N <br /> Sige -------------- - ----- ---------- - caner- ------ ------- <br /> By Title ---------------- air <br /> - <br /> ......... <br /> (If other t an owner) "I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ DATE <br /> CA k ---- - --------- ---------------- <br /> -------------------------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----I------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------- <br /> ------------------------------------------------------------------------------------------------------------------------- ---------------------- --------------------r------------------------------------ <br /> -------- - - -----------Do <br /> - ----------------- -----------------------------------------------------------------------Date------ <br /> Final Inspection by:' A I -- ----------- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ -E. H. 9 _1-'68 Rev. 5M <br />