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FOR OFFICE USE, APPLICATION FOR SANITATION PkRMIT,,. <br /> -------------------------- ------------------------------ <br /> (Complete in Triplicate) Permit No. 7Q 7b� <br /> (? <br /> Date Issued --- ��-7_ <br /> ------------------- This Permit Expires I Year From Date Issued - /1P <br /> Application is hereby made to the I San Joaquin Local Health District for a per"mit 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 .�Lvo_o ----_-----.-------------_----CENSUS TRACT Y-------- <br /> 9Pk,_J2-------------------------------------- ---------Phone ---------------------- ------------- <br /> Owner's Name <br /> City ------------------------------------- ------ <br /> Address ---------zq-- <br /> ---- ------ -- ----—-------- - .... <br /> _�_ _,___1&_..License # ------------------------ Phone ------------------------------ <br /> Contractor's Name --- -- - --- - -- --------- <br /> I <br /> Installation will serve; Residence Apartment House❑ <br /> Commercial :E]Traller Court !F] <br /> Motel E] Other ----�_t ---------- --- -------- <br /> t ---Garbage Grinder ------------ Lot Size ------------A <br /> Number of living units._-,-- Number of bedrooms --------- <br /> i <br /> Water Supply: Pubfic System and name ----------------------m----------------------------------------I-----------------------------------------------Private <br /> i <br /> Character of soil to a depth of 3 feet: Sand'[] Silt C] ' Clay E-] Peat E] Sandy Loam Clay Loam .E] <br /> Hardpan E] Adobe-E] Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pla ced on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TAN K Size_,3-A-_1_ ------------------------- Liquid Depth <br /> tq � <br /> Capacity t, <br /> ----'-'Material__0 ---- No. Compartments -;)------------------ <br /> Distance to Weare t: Well ------------5it_I--------------Foundation ------t-0 ------- Prop. Line --------------------- <br /> LEACHING LINE No. of Lines ________l_______________ Length of each line----------YO-------------- Total Length ---- <br /> BOX J_____.___ Type Filter Material _'_____Depth Filter Material ---- ------------ ----------- <br /> Distance to nearest: Well -----`�Iq------------- Foundation _____L4- ---------- Property Line __S'___...__._____-_-___ <br /> SEEPAGE <br /> !....... -------- <br /> SEEPAGE PIT Depth" --------------- Diameter ------------------t Number ----------------------------- Rock Filled Yes f] No Cl­ <br /> Water Table Depth -------------------------------------------------Rock-Size -------------------------------- <br /> Distance t; nearest. Well ________________________________________Foundation <.____.___-__---.____ Prop. Line _________.______--___- <br />{ <br /> REPAIR/ADDITION(Prev. Sanitation' Permit# -------------------------------------------- Date ------------------------------ <br /> Septic Tank (Specify Requirements) ---- --- ---------------------------------------------------------- -------------------------------------- ---------------------------- <br /> I <br /> DisposalField (Specify Requirements) ---------------------- -------------------------------------------------------------------------- ----------------------------------- <br /> ------------------ - --------------------------------- ---------------------------- --------------------------------------:--------------------------------------- <br /> ------------------------ <br /> ------------------------------------------------ ------------------------------------------------ -------------------------------------------------------------------------------------------- <br /> -- <br /> I (Draw existing and required addition on reverse side) I <br /> I hereby certify that I have prepared this application and that the; work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. 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 person in such manner <br /> as to become subject iyrkman's Compensation laws of California." <br /> Signed ------------------------ _U------ ---------- ------- -- --- ------------------------- Owner <br /> 04 <br /> By ------------------------------- Title ------- ------------- ---------------- <br /> (if other than owner) <br /> FOR .-DEP -RTMENT USE ONLY <br /> APPLICATION ACCEPTED --------------------------------------------------------------- DATE A0—-16.___70------------------- <br /> BUILDING PERMIT ISSUED ------------------------------------------ --------------------------------------------------------------DATE -------------I------------------------------ <br /> ADDITIONALCOMMENTS --------------------------------------------------------------- -------------------------------------------------------------------- --------------------------- <br /> -------------------------------------------- --------------------------------------------------------------------------------- -------- --------------------------------------------------- ----- ------- <br /> ------------------------------------- ------------------------------------------------------------------- <br /> --------------------------------- - -------------------------- <br /> Final Inspection by: ---- --- -- <br /> --- --------------------------------------- --------------------------------------------------------Date Zb---- -- ----- <br /> ------ <br /> ------------------------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />