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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> 1G.i�- -------------------------------- - - - ------ Permit Na. <br /> (Complete in Triplicate) <br /> ----------------------------------•---- --------------- <br /> t Date Issued __--6...... 2- <br /> ---------------- ------------------:--------------- <br /> --------------------------------------------------- This Permit Expires ] 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 /> F <br /> '-` i'! til ------CENSUS TRACT -------------- ----------- <br /> JOB ADDRESS/LOCATION __��x,.�'_�--- �-�-�-�-------=-----='r--�---°------------------------ ------------------------- <br /> ._..........-- . <br /> Owner's Name -----`�` -�"�/�i�-��--- �-�__��::��f_------`--------------•------•---•-- - ------ <br /> r <br /> ! Address ------ ,� Jl%.-- 1 _ •°+ ' ---- City _- =.�i✓== <br /> V. Phone <br /> Contractor's Name ___ �/ � ,.. fl,f__.__•--17 <br /> 1 <br /> -.. ..License #��l`-�.- `-'�--=-�-�- one <br /> f Installation will serve: Residence P'Apartment House❑ Commercial:❑Trailer Court ,❑ <br /> ' Motel ❑Other -------------------------------------- <br /> Number of living units:--/------ Number of bedrooms �" -_____Garbage Grinder }'1_t__ Lot Size f41d__%::4'° :r __''`__..___-___- <br /> Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Privats-Q <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt I-] Clay Peat❑ Sandy Loam ❑ Clay Loam-❑ <br /> riHardpan Q Adobe ❑ Fill Material ---------,__ If yes,type ________________________--- <br /> (Plot plan, showing size of lot, location of system in relation to- wells, buildings, etcmust be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` <br /> ' PACKAGE TREATMENT [ I SEPTIC TANK Size C- 't_ --- .----•-•----- Liquid Depth - ------------------- <br /> Ca <br /> ------------------ {� <br /> Capacity 1//CV----- Type ".s' :%'._ Material.- -elf -:- No. Compartments <br /> Distance to nearest: Well ____ _ ;? _ ___-__-Foundation ... Prop. Line . °�� :y...'... <br /> LEACHING LINE No. of Lines ____-�gl--__.__ __ ___ Length of each <br /> -------- ...... Total Length /_ _".._..._..__ <br /> D' Box _ '_ Type 1 filter Material ' Depth Filter Material ----------- <br /> r <br /> ' '. Pro r r <br /> Distan to nearest: Well Z_',2.6 __ __ Foundation , __.c_...,__-___ p,_ ty,._ -:,•_- <br /> SEEPAGE PITDe th y f __' Number <br /> p _.____ Rock Filled Yes No <br /> Water Table Depth ._.._.% Rock Size /-_-- _:_______________ <br /> p � <br />' Distance to nearest: Well .__ __ _�_______-___--. Foundation __�`_, �.._ _ Prop. Liner�L,?........_�..__ <br /> ii REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 <br /> E!� ------------------------z..--------------------------- <br /> Septic Tank {Specify Requirements) -•------------------------------------------------------------------------------------ <br /> Disposal f=ield (Specify. Requirements) ------------ --• --- ---- _ _ -----------------------•---•----------------- <br /> --------------------- -- ----- ------------------------------------------------------------------------------------------------------- ------------------------------ _... ------------•---- <br /> -------------------------------------------------------------------------------------------------I --------------------------------- -•------------------------------------------------------------------ <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 /> F "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 to Workman's Compensation laws of California." <br /> Signed ------------------ ------- / --------------------------------------- Owner w_ <br /> B ( _ i - ►, /' ar�r e _ . -_ -� '�''- ----------- -_-------------._.- <br /> Ii <br /> Y ----------- ------- w « Ti i <br /> other than owner) <br /> ! FO PARTMENT USE ONLY -� <br /> APPLICATION ACCEPTED BY ----- ---- • -------- - -------------- ---------------- DATE <br /> BUILDINGPERMIT ISSUED -------- ---- -------------------------------- ------•----------------------------------------DATE ------=------------------------------------ <br /> �j ADDITIONAL COMMENTS -------------------------- ----•-----•------------ -------------- --------------------------------------------------------- ----------------------------------- <br /> F 1 ---------------------------------------------------------- <br /> -------------------- <br /> -------------------------- ----- ------•------------------ - --- ---- <br /> -- <br /> ---; <br /> ----- <br /> -------------------------------- ----- - <br /> Final Inspection b ------- --------------------Date . ✓= <br /> p <br /> Y• ----------- ---------- ------ � <br /> � r <br /> SAN -JOAQUIII LOC HEALTH DISTRICT <br /> E. H. 9 1-'68 R,-.v. SM <br />