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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7�_ <br /> (Complete in Triplicate) <br /> Permit No- -------- - -------- <br /> ------ This Permit Expires 1 Year From Date Issued Date Issued .... __9-7 <br /> a 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 gmade in�compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _- 9�1-- -- )L"---- -�>-1✓-----a_ __._- _ CENSUS TRACT ---- - ------------ <br /> p / <br /> Owner's Name .. ..... M�-� /� -�-------•------------------- -.Phone O3S _S*.3.-� <br /> Address --------------- 1�F-'9 e.... . 17-��1i/ ------------------------------ City ----- G ------------------------------------------------ <br /> Contractor's <br /> --------------------------------- --------Contractor's Name 1'__.5'0,,4/---_----------License #� .:- Phone —A -------~0!Z/ <br /> Installation will serve: Residence [g Apartment House-E] Commercial ❑Trailer Court C] <br /> Motel ❑ Other <br /> Number of living units: _.- __ Number of �edrooms _._._.Garbage Grinder _*_0... Lot Size 1 _A'�'_. 5`_________-_---..._ <br /> Water Supply: Public System and name ---- ------- -- - ------------------------ -- -------------------------------- . --- ------..........._..Private �( <br /> m Character of soil to a depth of 3 feet: Sand'❑ 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,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---------------------------------------_-------- Liquid Depth - ___ ---------_-__._ <br /> Q <br /> Capacity Type --=-•-- ----- aterial---� No. Compartments .-��'----_------ v <br /> Distance 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 Material - ------ -------------...----------------._. <br /> Distance to nearest: Well . _ ----_----_------- Foundation __ ------ -------- _ Property Line _--------------_________ <br /> SEEPAGE PIT [ ] Depth ._.---.------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No L-11 <br /> WaterTable Depth --------------------- -------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well _��----------------__..__.___-_-__. Foundation .__f_-._______.,- Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -_. 4" -'f-_--__-_____..____-__ Date -- ----_ -_._______T_____________) <br /> Septic Tank (Specify Requirements) -AX-7-M-00—00-_--_ <br /> Disposal Field (Specify Requirements) - rq_� <br /> ________ _ __ ________ -------"_____� 5 �/?L}5____ f� _ _ �' `_... <br /> __.. Y LSA- -`-"".� Qom ` ---- ------ <br /> ( raw exis ing 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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed __ �1�✓L/ Q - - � -------------------------- Owner <br /> BY -- -------- -------------- Title <br /> 1 - --- <br /> (I other t an <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------------- <br /> -------••--•--- •------ •---•- - -------------- DATE --- .j'7Z" <br /> BUILDING PERMIT ISSUED ------••-- - ----DATE ............ -i <br /> ADDITIONALCOMMENTS ------•----- -- ---------•-------•-------• -----------------------•----------------------------------------------=---------- --------------------------- <br /> ------------------------ --------•-------••----------•--•------------------•--------------- ........----------------------------------------------- ------------------------------------------ -----••-- <br /> ------------------------------•-----------•-----------------------------------------------•-----------•------------------/Is <br /> -----------------------------------------------------•---- <br /> _ ------------------ --------------•-•------------------------------------------------------------------------------- -- --•-----••----L-----•--•-_-•--- <br /> FinalInspection by: -- --------------------------------------------------•--- - -------- - ........Date -__ =-�z ....................... <br /> JOAQUIN LOCAL HEALT CT <br /> E. H. 9 1-'68 Rev. 5M C0 <br />