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FOR OFFICE USE:. <br /> APPLICATION.F0.? SANITATION PERMIT <br /> - ---------------------------- <br /> (Complete in Triplicate) Per ----------- <br /> Date Issued <br /> --------- --- ----------------------------------- This Permit Expires 1 Year From Date Issued --- ---- - ------ <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit to construct and install the work herein <br /> described. This ap No ing u <br /> plic tio is made in compliance with County Ordinance 549 and eps t' Rules and Regulations: <br /> CENSUS TRACT -------------------------- <br /> -------------------------------- ------------- ------Phone ------------------------------------ <br /> JOB AD RESSAOCATION - ----- <br /> • <br /> Owner's No�ne ---C_A4r.X_ <br /> Address -------- - -------------------- City --------------------------------------------------- ------------------------ <br /> Phone <br /> Contractor's Name --------------- Ak ------------------------License #j ."---------------------------- <br /> Installation will serve; Residence <br /> partment House-0 Corhmercial,-4 Trbi'lee Court ',F-] <br /> i <br /> Motel F-l Other_________________ ---- ---- <br /> Number of living units:---------/_ Number of bedroom's ------Garbalge Grinder <br /> Lot Size ----------------- <br /> Water Supply: Public System and name -----------=------------------------°=----------------------- ------------- ------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'F] Silt E] Clay Fj_ Peat F] Sandy Loam E] Clay Loam F] <br /> Hardpan E] Adobe ill Materialb 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 /> I <br /> NEW INSTALLATION: (No septic tank or seepage it permitted if public sewer is available within 200 feet,) <br /> k I <br /> PACKAGE TREATMENT [ ] SEPI IC Si Depth .0_2------------ <br /> 1 p--------- --- Liquid C <br /> Capacity V Type aterial?:�;---------- No. Compartments ---------------------- <br /> istance to near st. Well ---- ------------------Foundation, Line — --- <br /> ----- ------ <br /> Z-417 -1 Z <br /> K No. of LiLs ------------- Lerigth f ------ Total Igth <br /> LEACHING LINE n --- o Acich line.-A64, �er ---------- <br /> Type Filter Material &A- --Depth Filter Materiol ----------------------------------- <br /> 'D' Box 1� <br /> 2 Property Line. -- ------------ ---- <br /> �4/ Distancel tb nearest: Well ----------- Foundation -------------- <br /> SEEPAGE PIT' Depth Diameter Number ------- ----------- Rock Filled Yes R; o C1 <br /> Water Table Depth -------LQ -------------------- -------Rock Size _Ty f—-—--------------- <br /> Distance to nearest: Well --------/V _f1t—_________________Foundation -------- Prop. Line ------------- <br /> rt <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _______._______`-_a_______________________ <br /> Date ------------j-------------:-------- <br /> Septic Tank (Specify RequiremenU4 <br /> ts) ---------,----------------------------------------------i) <br /> -----------------------------I---------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------------------------------------------I--------------- <br /> I <br /> I- <br /> ------ -------,------- ---------- ----------------------I ---- ------------------- <br /> -------------------------------------------------------------------- --------------------------------------- -------- <br /> ----------- -------- ------------ -------------------- <br /> ------------------ ------------------------------------ --------------------- ------------------------------------------------------------- <br /> (Draw.existing and required addition on reverse side) <br /> I hereby certlfy/thaf I have prepared this'application and that the work will be done in accordance with Son Joaquin <br /> I <br /> Ul L tijj� <br /> County Ordinances, State Laws, and Rules and Reg a FiS�a f the Son Joaquin Local'Health District. Home owner or licen- <br /> sed agents signature certifies the fcillowing* <br /> "I certify that. in the performance ;f the work for which this permit is issued, I shall not employ any person in such manner <br /> as to-beiorne subject a Workma '! n_pensation laws of California." <br /> a a s <br /> Signed ---------- ----------- ---------------------------------------------------- Owner <br /> A <br /> ------------------------------ Title ---------------------------- --- --------------------------------------- <br /> By ----------------------------- - --- ----------------- <br /> I(If oth t w <br /> e _h n owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .....:f' <br /> DATE <br /> -- ----- ---- ----- - - ------------------------------------------ -------- <br /> -- <br /> --------------------- <br /> BUILDING PERMIT ISSUED ----------- ---- - ----------------------- ------- - -------------- --------------------------DATE ---------------- -------------- <br /> A - ------- - - - ---------------------------------------------------------------------- <br /> QUI 1,,�UNA ---------------------------- <br /> ------------- ----- --------------------------------------------------------------------------------------------------- <br /> V X <br /> ---- ---- ---- ------------------------- ---- -- <br /> - - - --------------------- - --------------------------------------------------- ------------------- <br /> - <br /> -------------------- - ------------- -- --- - ---- --- - -- --- - - --------- ------------------------------------------------------------------ ------------ ------ <br /> Final Inspection by: ------- ------------------------------------ --------------------------Date ... --- -- ----- <br /> JO UIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />