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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: _Gn_1--^__�-1•.1 <br /> ------------------- ---"""--""--- (complete in Triplicate) <br /> - ------------------------------ - <br /> Date issued _. -�- - / <br /> This Permit Expires 1 Year From Date issue F <br /> struct and <br /> l the work herein <br /> i by " Ii- - <br /> . .. .. _ _. rdina ce'No`549 and' <br /> Applica#ion is hereby made to the San JoaquinIian tical hHealth <br /> Co District for a permit to con ex sting Rules-and Regulat onsc- <br /> described. This application is made in comp � S T --- <br /> N <br /> JOB ADDRE55/L TIONIL�o -- . ., :R 1 "Phone s� . <br /> TRACT <br /> -------------- <br /> �.. __ <br /> - ------ -------- <br /> Owner's Name t ---------------------------------•----- <br /> jz <br /> y. <br /> Address 4 r t Phone <br /> -------------- t , <br /> Contractor's Name _--- - --- <br /> 1 � cense <br /> Residence Apartment blouse,❑ Commercial:❑Trailer Court ;❑ <br /> Installation will serve: 1 <br /> Motel ❑Other ------------------------------------------- �� _ <br /> rr Garbage Grinder --.-------_ Lot Size ----_ -- <br /> Number of living units:_"--_d---___ Number of bedrooms ___ -____-• ,xr <br /> :- Private , <br /> - - <br /> - - --- --------------------- ----- - <br /> =i <br /> Water Supply: Public System and name -------------------------------- y---F-1-----Peat-F­1 Y ❑F1 Sand Loam Clay Loam.E] <br /> Character of soil to a depth of 3 feet: Sand❑ Silt 0 C!--a- <br /> ' - If yes,type Hardpan ❑ Adobe A Fill Material -- -------- a ------- -------""`""" ---- <br /> buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of system in relation to wells, <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK'f } <br /> Size --------- Liquid Depth -------------------------- <br /> - No. Compartments __--------•-----•---•- <br /> Ca acit --t Type -------------------- Material------------------ -- <br /> A Yk. �-- . <br /> "�_ - --------Foundation -------------- ------- Prop. tine ----------•----------- <br /> Distance jto nearest�Well --------------------------- <br /> -' -- Length of each line-------------- Total Length <br /> LEACHING LINE [ ] No. of Lines "_-j g <br /> ______________"-----De Depth Filter Material --------------------------------------- <br /> 'D' Box-. Type Filter Material ----- <br />( Distance to nearest: Well ------------------------ Foundationry-+-_- _� <br /> ----- Property Line <br /> - Ditatneter Number -------------- ------------ Rock Filled Yes [] No <br /> r ------------- <br /> SEEPAGE PIT [ ] ept �` <br /> D =----Rock Size -_ <br /> ----------------------- <br /> W,dter as Ib'Depth ------------------------- - ti <br /> W <br /> Pro Line -. <br /> � stanCe to'nearest: Well ---------------- -- Foundation j_-_ p <br /> Date `"""';--------- ti ) <br /> REPAIR/ADDITION'(Prev. Sanitation Permit# ----=------------- -------- ti <br /> 4#` 1 --------------- <br /> Septic Tank'(Spec�fy Requirements) _---- - <br /> ` '• <br /> -- <br /> I --------- <br /> Disposal_,,Fiel (Specify� Requirements)---------- <br /> ------------ <br /> 0 <br /> _ --- -- "" ' a , <br /> - --------- --- --- ._ <br /> "`yj (Draw existing and required addition on reverse side) <br /> e in <br /> n Joaquin <br /> 1 hereby certify that F�i,;%,prepared this nd`Regulationse that <br /> of the San Joaquin LocalHealth District. Home ce etowner or lite <br /> County Ordinances, State Laws, and Rules <br /> sed agents sig a,+} acertifie the follovii' g: .x <br /> "[ certify�thut hn #'h prfarmance of a ork for,wheih this ermit is issued, 1 shall not employ any person in such manner <br /> t to Work a ' pens tipn bws of alifornia." <br /> as to bec . .. I <br /> Signed � -- -.- _ . <br /> � ---------------------------------------------- <br /> - --------------- ------ ------------------ -- <br /> Title <br /> By <br /> (If other than owner) <br /> OR DEPARTMENT S LY <br /> ------ -- <br /> - DATE -- 47/0--�-� ----------------- <br /> APPLICATION ACCEPTED B - ------- ------ -------- --------- ----------------------- <br /> ----------- --------- ------ --------------- --• ------- ----- <br /> BUILDING PERMIT ISSUED _____----------------- - --- <br /> ---------------- <br /> ADDITIONAL COMMENTS _----"-------------------------- -------------------- <br /> ----------------- <br /> ­----------- ---------------------------------- ---------------------- --------------------- <br /> --- ----------- --- <br /> --------k--------- <br /> - ------------------ <br /> -- ------- -- ____ ------.Date _ <br /> -�8- <br /> Final Inspection b <br /> -- ---------------------------------- <br /> SAN JOAQUIN LO HEALTH 1STRICT <br /> E. H. 9 1-'68 Rev. 5M - <br />