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FOR OFFICE USE: _/ <br /> APPLICATION FOR SANITATION PERMIT n,i� <br /> - _ ------------- <br /> (/0 Permit No. ._ .� <br /> (Complete in Triplicate) tSt�r/vOvvf _ ---S....y <br /> Date Issued _606 �`/ <br /> ----- -------------_-----_-_--------_ This Permit Expires 1 Year From Date Issued <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 ------61mFE�Uamoo----- ----h�Wy----L_3�----'--//--------J------- ..CENSUS TRACT ---�-$--_-------- <br /> Owner's Name ---------------------epG..r�1------------- �' /7. .W/-1 Z. -- Phone ---- - - -- - <br /> �. y ... <br /> Address -- ---------P0--,90P---4�3-------- ------ ---------------- ........... City --- --- ----- ------ ------ ------------------ <br /> Contractor's Name ------ --- -- ---------------------------.License # -- ... --- - - Phone .-------------- -------- <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑?Dit er _.-1' b�l}� ---------------- <br /> Number of living units:-----r_--- Number of bedrooms _--?-.---Garbage Grinder ----.---- Lot Size -------- A <br /> Water Supply: Public System and name ------------------ ........----------- ------------------------------------ --------------------------------Private Q_ <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe (-Fill Material ------------ If yes, type ......-__----------------- <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,) NO <br /> PACKAGE TREATMENT [ ] SEPTIC TANK[ 3� Size-----.1�-- j Liquid Depth ---- <br /> Capacity <br /> __ ..-__-.-----_- <br /> n CS`=- <br /> Capacity -.�aFS[�------. Type - .___. Mate-rial_-&U, __ No. Compartments ..�k;.._...----- <br /> Distance to nearest: Well -----.--------------------_--------Foundation ........_---_____ Prop. Line .............. ------- <br /> LEACHING LINE [ ] No. of Lines -- -------_------------ Length of each line____._--------- ---... Total Length ----------- <br /> 'D' <br /> --_-_--_'D' Box ------------ Type Filter Material _-.......----------Depth Filter Material ----------------_._-_--.- <br /> Distance to nearest: Well .-_-------O-J-/_�-,-------�. _. <br /> '..Foundation _.-___-__-.___. Property Line ------------------ _. <br /> SEEPAGE PIT [� Depth _-_A1.1-..-.---- °Diameter(d(_ ...C,C2- Number -__---------------/;-.----- Rock Filled Yes ©�No ❑ <br /> Water Table Depth -----------.�_-___-----__---------------Rock Size ------_---_--__ Lp <br /> Distance to nearest: Well -_----------------.---------_.......___Foundation __ --------------- Prop. Line ....._.....__-_ ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........_______..------- ---------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) -------------- ...... ---------..................... ......... ------------------------------------ --------- <br /> Disposal Field (Specify Requirements) --------- .......... ------------------------------------ <br /> --------------------- ----------------- --- ---- ----------------------------------------------------------------- ------- - -- ---------------- -------------- _ <br /> --------------------- ---- - - --- -------------------------... <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: <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 /> at to become ubject to Work Compensation laws of California." <br /> Sign <br /> ,Z" .......: .°--- --------------..--...-_.--.--.__ Owner <br /> By -------------------------- --------'--------------------- ---- ...................... Title ....... <br /> . ... ............ <br /> (If other than owner) <br /> FOR DEPARTM ONL <br /> APPLICATION ACCEPTED BY ----------------------------- --- ------ - . _ - --------. DATE .... 1 / ------------ <br /> BUILDING PERMIT ISSUED -.--- ..... ---------------------- _ DATE ------------_---------..-_-..--_.-.-- <br /> ADDITIONALCOMMENTS .. -- - ._ A ............... _.. ......._....... ------------ --------------- - - -------- ---------------------------------------- <br /> - ---------------------------------I-------------- --------- ------ ----- ------- -------- -- ------------------------------------------------ --- ------------ -------------------- <br /> --------------- - ---- ------- - ------- ..... ----- ----------------------------------------- <br /> ------------------ - <br /> Final Inspection b ----- - ---- ---- - --- ---- - ... - - Date -.: ��'�1...- --- --- <br /> - - ---- -- <br /> SAN JOAQUIN LOCAL HEALTH DI ICT <br /> E. H. 9 1-'68 Rev. 5M ( r frJ <br />