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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .......... Permit No. :�2� <br /> (Complete in Triplicate) <br /> ............'..............I................ <br /> ............................................ This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per to 'construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549rand'existing Rules and Regulations: <br /> JOBADDRESS/LOCATION ........:......-� .'�.J-_.......�< .........................CENSUS TRACT ............,........ <br /> -2 <br /> Owner's Name .-�c.G' �� ------------------------------------•---... .................................. ................... hone <br /> ..._. .. P <br /> l .� <br /> .N <br /> Aadress <br /> ................. -- 1 - City 1 �1 ......... .......................... <br /> :. . <br /> Cont�actor's Name �.�.... .�-�1 ........... •---.License Phone <br /> i <br />- <br /> Installation will serve: Residence Apartment House❑ Commercial []Trailer Court 0 <br /> Motel ❑Other ... ........................................ IN, <br /> Number of living units. Number Number of bedrooms 2/ 9 <br /> _....Garbage Grinder __----_-- Lot Size _ .................. ....••-••••.... <br />} �,� 1��•�3r7 -... <br /> .................................Private.❑ <br /> Water Supply: Public System and name <br /> •.._. t.n <br /> Choracterjof soil to.a depth of 3 feet: Sand ❑ Silt❑ Gay ❑ Peat❑ Sandy Loam {� Clay Loam <br /> I <br /> Hardpan E] Adobe E] Fill Material ............ If yes; type .-..------------ ------� <br /> (Plot .plan; showing size of lot, location ofsystem 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 /> Size.--•---•----- ---••.._-.-- --•--------- Liquid Depth ... ...........•-...------ . <br /> PACKAGE'TREATMENT { ] SEPTIC TA t ] -••••- <br /> Capacity --------- _ ....... Type .................... Material.---------------_... No. Comport e�............__....._. <br /> Distance to nearest: We .................._-.,-__,........Foundation ................-__ - rop. Line ..................... <br /> LEACHING LINE [ ] No. of Lines ..----.---------- _. _ 'ngth of each line.-.!-...................... otal Length ............................ <br /> D' Box Type Filter Mate ' I :..:�..._._. Depth Fie Material . <br /> ---• :.. <br /> Distance to nearest: <br /> Well'.. ---- ..,Foundoti ---------------------- Property Line -:..--- <br /> SEEPAGE FAIT { ) Depth ----------_------;. Diameter m`ber ---------------------------- hack Filled Yes ❑ No ❑ <br /> Water Table Depth !...Rock Size <br /> 1 Distance to nearest: Well .. .................................1. undation ..................... Prop.'-.Line;...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit .......... ................................ Date' .. ...._.. --------------------- <br /> } <br /> �_.. — <br /> Septic Tank (specify Requirements) .:--•--.....---•---...':;--.-;,-------:r---- ................................ , . . <br /> Disposal Field (Specify Requirements) .� ... .. f f6. -............ ....... <br /> ----------------------------------------------------------..... <br /> ---------- --------- ----------------------------------------------------------------------•--..--------------------•-•-•-----------------..... <br /> t r (Draw existing and required addition,on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be iIone 'in accordance with Son"Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San :Joaquin Local Hedith District. Home owner or licen- <br /> sed agents'signature certifies th`e following: r <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become sub' <br /> to W krna 's Compensation laws of California." ' <br /> Gj( <br /> i . ................................ <br /> aT-rr+r+.r n <br />` Signed m.,- . ��u-..- � .. �. •'Owner <br /> B .......--•.............................. ........................ <br /> Y -'---....-...?...................:.....................--.......--•---�•--•---.....---------=�F--;--.:.. Title -. y. ..- _ ., ...., <br /> { (If other than-ownerl-- <br /> FO E RTNIENT USE ONLY _ <br /> APPLICATION ACCEPTED BY .......................... _: DATE....... .: ..-`----.... .......... <br /> BUILDING PEf2MIT ISSUED- ...,.,., ....�,n. - .._ �:... <br /> € ADDITIONAL COMMENTS ........................... ......=............................................................ ....................................... --------------- <br /> --.- ......... <br /> i. '................................... - ..... _.._. • ...:....' _ .................................... <br /> -- --- . _.. f <br /> f --------------------- ----------- <br /> 4;0. _.... f <br /> _., {, <br /> --��,.. - <br /> Final Inspection by: ...:................ Date <br /> --------------------- -- <br /> 1 _ SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> _ ._ y 9r. - .._ .. _.. 7/72 3 M <br />