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FOR OFFICE USE: <br /> I APPLICATION FOR SANITATION PERMIT <br /> ---------------- ----- <br />' - (Complete in Triplicate) Permit No. <br /> ------ This Permit Expires i Year From Date issued Date Issued __:f �(.q <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/LOCATION . ___ fir _- ff ®.g � .,S'! ,�'± 4,� �. Ila �''�7 S T�c/le� <br /> - ---CENSUS TRACT _- <br /> ---------------- ----- <br /> Owner's Nam U � 1�QJZ-------IAI--e--------------------------------- ---- --- -----------.Phone - 1 <br />` Address ......�,;E)--��-- Q -------/,4�---------------------------------------------------- <br /> City _��-_"j�C',�--_.---- <br /> Contractor's Name -__._ - r* +-1 y-partmen­t <br /> ., ----------------------- <br /> ��•--- � -� lL.:�l_��2��--.- -.License #c.�S�-3.S�----- Phone�r.-�i'a-=-/�C�3--1 <br /> Installation will serve. Residence _7.. ` ' <br /> House❑ Commercial railer Court <br /> Supply: /f� ge Grinder __.______ Lot Size <br /> Number of bedrooms Motel El ar <br /> _1._"�� <br /> Number of living units: Nu _ <br /> � /Y�__Gba __-_l___ <br /> Water Su I I Public System and name __---_--- _-___-__ -------� ------------ <br /> --------------- - ----------------- ----------Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Loa❑ Sand y, m Clay Loam.;❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ___- ------- If yes, type -_'__- �_------------- <br /> (Plot <br /> .---v_- -(Plot plan, showing size of lot, location of system in relation. to-wells, buildings, .etc, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK [ ] Size__ ?x <br /> Capacity <br /> --- ___ Liquid Depth --</-�------ -- o� <br /> 00.. --- . <br /> --------------- <br /> r Type -------------------- Material----_- � No. Compartments --- �. <br /> Distance to nearest:1 Well ----_---5__ _______ ___________Foundation __/D----------- <br /> --- Prop. Line -----s-----•-- ------ <br /> LEACHING LINE [ ] No. of Lines .__�___ ----------- Length f each line.__ SD----______.__ Total Length ------ ____I---------- <br /> 'D' Box Type Filter Material/10121/_,_Depth Filter Material _-_- -r <br /> Distance to nearest; Weli -_--?""--�__--�"___---'- Foundation _____________ ____`� Property Line <br /> } i ------------------- <br /> SEEPAGE PIT [ ] Depth Diameter _ ____________ Number _____--__-_-- Rock Filled Yes ❑ No I <br /> Water Table Depth ------------'------ --=------- ------=----- --Rock Size ----- ---------- ------ <br /> Distance to nearest: Well ._-__-_____1___*---_-----_-_--__----,!Foundation ______---_._ <br /> I -------- Prop. Line ----------- ----------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------__-I____t________________------------------------ Date ---------------------------------- <br /> ------------ ) <br /> Septic Tank {Specify Requirements) I <br /> - ---- -------------- <br /> - ------ <br /> Disposal Field (Specify Requirements) � _ '� _ <br /> ---- --------------------------------------------------- <br /> t <br /> ------ ------------------------------------------- -------------------------------------------------------- J <br /> (;Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San 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: I } <br /> "I certify that in the performance of the work for which this permit is issued I shall not employ an <br /> as to bec rn sub'ect #a Work "s p P Y y person in such manner <br /> � ensation lows of California." <br /> Signed - - - - -- r- _ ...R._.�.; <br /> • ------ -,�•� f caner 7�7A--------------------BY - lfG lC�- Title _-(If other t an owner) FOR .DEPARTMENT USE O °•'-•-A <br /> LY <br /> APPLICATION ACCEPTED BY ___--- <br /> ______ <br /> BUILDING PERMIT ISSUED ------ ---------- <br /> - ------_-- - ---- - ------ -- - - - <br /> DATE <br /> - --------- <br /> TIONAL COMMENTS ---------- - I-------- - -------------- ---- ----- --- - <br /> -DATE -------------•--- ---------- -- <br /> --------------------------------------- ----- <br /> - -------------------------- ------------------ <br /> ------------------------ <br /> --------------------- <br /> Final Inspection b - -------------------D--a--t- <br /> e -. <br /> /c/ 7 <br /> - -- -------� ------------------ <br /> SAN JOAQUIN LOCAL HEA ISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />