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2 ' FOR OFFICE USE- <br /> APPLICATION I'M SANITATION PERMIT <br /> - ------------------�----- ---------- ---------- Permit No: - - - <br /> (rmplete in Triplicate) <br /> - <br /> -------'------------------------- ------------ This Permit Expires 1 Year From Date Issued <br /> Date Issued -----7---------- <br /> .1-11 <br /> f,. <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. 5.49' and existing Rules and Regulations: <br /> p --t-� _._____ <br /> JOB ADDRESS/LOCATII�O�N --- _ -------- -A— <br /> 14 - ----------------- - ----------- <br /> CENSUS TRACT <br /> rOwner's Name ------ ;------ f` —---------------------------------------------------Phone --------- ------------• ----------- <br /> Address --- --------A_D_ o-V--- -------=------------5-------------------------------------------- Cit -------------------------• --------- <br /> Contractor's Name -f>/q f 4- -I._I��----- f____----- �'----------------------License # -------- Phone ----------------- <br /> Installation will serve:: Residence ❑Apartment House E] Commercial ❑Trailer Court ❑ <br /> Number of living units:______. Motel E]Other -------------------------------- <br /> Number <br /> _____-___________________� � / <br /> g ____ Number of [iedrooms __ __--Garbage' Grinder 1'40 9-_ Lot Size _ _ ( �------------ <br /> Water Supply: Public System and name ______.f--__.____: - - ` _____Private�� <br /> ---------------- <br /> K � �t ❑ Sandy Loam ❑ Clay Loam [ � <br /> �. ------------------------------ <br /> Character.of soil to a depth of 3 feet: Sand'E].��+Silto_ ' Peal � _ <br /> Hardpan ❑'T, Adobe '❑ Fill Material ------------ If yes, type ---------------------------- <br /> (plot <br /> __---------- ----- ------(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 if public sewer is available within 200 feet,} <br /> W <br /> PACKAGE TREATMENT I ] SEPTIC TANK.'[ ] Size------------------------------.__---------------- - Liquid Depth --------- ---------- <br /> Capacity -------------------- Type - ------------- -- Material------------ -------- N . -Compartments -------------_------ Q <br /> IDistance to nearest: Well -- ---------------------------------Foundation --------- ------------ Prop. Line -----------..--.------ <br /> LEACHING LINE [ ] No. of Lines ________________ ______ Length of each line.____________._------.__._ Total Length _____..__________--._._.__ <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Ma rial -------------------------------------------- <br /> Distance to nearesf:-Well -- - _` Foundation '---'_____________ ----___ _Property Line. __________-___---.----- <br /> SEEPAGE PIT [ ) Depth ____________________ Diamet r ---------------- Number - --------------------- _._ Rock Filled Yes ❑ No i❑ <br /> ' Water Table Depth <br /> ------------------------Rock Si <br /> ------------- ---------- ze ------- --------- ---------- <br /> Distance to nearest: Well _____________Foundation _____ Prop: Line -------- ---------- <br /> ------------------ -- <br /> REPAIR%ADDITION(Prev. Sanitation Permit# _____.__-___ ------------- Date --------------_____ ______________) <br /> � <br /> Septic Tank (Specify Requirements) [ '-P _ }r <br /> _ _ ` Q�= — �i1�C P Cj3 S5"'- - -�"------------- <br /> Disposal Field (specify Requirements) ___1.�-.�-�--------�.r=f <br /> t---- -- -------------' ,�/t------ -------------------------------- <br /> ------ <br /> ---AbDIT ------ ------ <br /> _._ - ---------- -- -� '� --- . <br /> Ems-= S'T �` <br /> - .{Draw existing and required addition on reverse side) <br /> i I hereby certify that..I have pared this application and that the work will be done in accordance with San_Joaquin <br /> k County Ordinances, State-_1awi', 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, Ushall•not employ-any.person in such manner <br /> as to become subject to Workman's Co pens tion laws of California." <br /> _ r <br /> Signed . - ----- ------ --- ------- Owner <br /> BY ---- --- ---- -- ------------------- '-Title ---- <br /> other <br /> --other than owner) <br /> t FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----- --+f- -------- ------------------------------------------------------------------• DATE -------_'`-1_'"7 ---------- <br /> BUILDINGPERMIT ISSUED ------------- --------------------------------------------- -- - ------- --------------DATE ------------------------------------- --- <br /> ADDITIONALCOMMENTS --- - -- ------------------------- -- -------- --- --- ----------------- ------------------------------------------------ ------------------------- <br /> ' ---------- ------------------------- - ------- - ------------------------ -- -- - ---------- ----------------- ------------------------------------------ <br /> -- ------ ------------ - - --- �f� �- <br /> --- <br /> Final Inspec ------------- ---- ---• '-------------------= -------.Date --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68.Rev. 5M <br />