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If i1.• <br /> FOR OFFICE" USE: <br /> APPLICATION FOR SANITATION PERMIT _may <br /> - Permit No. --- <br /> '. ---- (Complete in Triplicate) <br /> ---------=------------------- <br /> -------- - -------- Dfjed <br /> --------------- This Permit Expires 1 Year From Date Issued i <br /> Application is hereby made to the San Joaquin Local Health District for--a permit to co struct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and,existing Rules and Regulations:,' <br /> VrCENSot <br /> JOB ADDRESS/LOCATION C--__%--- z -7_-- �✓ ------ ------------- ' '� TRACT <br /> Owner' tp <br /> Owner's Name CLQ--�et ------ /T'±`" i�'+ ± ----- Phone .:9 � � <br />{; r ,4. <br /> Address ._r -� r9�,:• .............. <br /> - Cityti W <br /> Contractor's Nam _"_.' ra---�. ----- =----)--.License # -------------- 'P}tone <br /> Installation will serve. Resi4nce-EjAq5'a_rtment House-E] Commercial`:OTrailer.Court ;❑ <br /> s Mote! ❑ Other----------------------------------------- <br /> - .� <br /> Number of living uni#sem.._-_______ Number of bedrooms-. _ _-_-�-___ t Si <br /> --___Garbage Grinder _ Loze :_•__ _,_ _�__ � � <br /> F_. q� <br /> Water Supply: Public System and name --------------------- --------------------------------------- ---------t Private <br /> Character of soil to a depth of 3 feet: Sand[] ;Silt❑ � Clay'z❑ 'Peat❑ Sandy Loaam ❑ Clay-Loam ❑ . <br /> I <br /> p ❑ Adobe-20 .: Y YP <br /> Hardpan Flll Material If e�A�#, e ,0 1 <br /> I cati n of system in relation to wells, buildings, etcl must be' placeon reverse side.) <br /> (Pl'ot plan, showing size of 'lot, o a. y � <br /> NEW INSTALLATIO[I:a --(iVo se'�ptic tankVor sermitted if public sewer is available with�ih 200 feet,] r y <br /> PACKAGE TREATMENT [ ] EPTICTANK�[eeps it pSize/'C_'' _- --------- -��------- Liquid Depth --- --- __. <br /> CaPACit-Y04200--- Type --------------- -- Material-------------------- No. Colmpartm ants t- y <br /> tante to nearest: We11 ,[y�✓ .__- -_____--_Foundation _ t _+ _____-_ Prop.;Lme .- -�_ T..--.-- (Al <br /> s € - <br /> ---- -- ------ ----- Len of each line-_': Q ------ Total 'Length �______-•-•-- <br /> T a Filter Material <br /> it <br /> -6 V` <br /> LEACHING LINE No. of Lines Length <br /> Depth"..Filter MatPial ____ _��'fit____________________________ <br /> D' Box __ YP �. - <br /> Distance o nearest: Well -,;&7.7$/ <br /> - Foundation ------------ ----------- Property-Line ____ __. ...... <br /> SEEPAGE PIT [ ] . Depth ____------- ------ Diameter ----- .......____.__ ___ ``_________ Rock Filled Yes �No BC <br /> Water Table Depth -------- --------- Rock Si <br /> at ------ <br /> Distance to nearest: Well -------------------------------- Foundation -------------------- Prop. Line ____...--- -__-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# ------------- <br /> - ---------------- <br /> Date ----------------------------------1 <br /> Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------- - --------------------- <br /> Dispos-al Field (Specify Requireme'n'ts) ---------------------------- - - ------------------------"----------------------- , <br /> ---- <br /> l7 --------------------------- ------------------------------------------- - - ------------- -------------- ----- - -------------------- <br /> f - ----- - -------------------- <br /> (D awexisting and r�qui;r481 dition,on reverse side) <br /> ! hereby certify that I ha repared dthis application a7iel lidt�th`e work" will be done in accordance .i, San Joaquin <br /> County Ordinancp'' t e Laws, and Rules-and-Regulations-of-the San��oaquin iocal_H Ith District. Ho1. me owner or licen- <br /> sed agents signature certifies the following: f <br /> "I certify that in the performance of the work forissuwhich this permit is ed, I shall not employ any pars Pin such•mannet <br /> I as to become ybject to Workman..s C " pensl tion I ws of Californi€" <br /> I } <br /> Signed ---- ------- - --- Owner 9 <br /> BY ----------------- ------------------------------------- ---- ---------- -----------. Title = <br /> -- - - <br /> •(If other than owner] I <br /> k <br /> FOR DEPARTMENT USE ONLY r _ <br /> �- r DATE '" '' . <br /> APPLICP;110fV gCCE=PT'ED"-RY"- 1+7- <br /> BUILDlNG PERMIT. ISSE3EDi - DATE <br /> *; ADDET-fflNAL-COI+hlVIE .--.." - ------ --- `- _ ----- '_"e .T.Y.�:..»�..�-_� , <br /> t --- ---- <br /> d - r -_ - ----- ---- ------------------------------------- <br /> W" � - - -------------------------------------------- <br /> ----- --- ------ -- -—--- <br /> _ ,syr' <br /> q= <br /> W. <br /> r. .. to <br /> F{rtia l I ns pecta o+�� <br /> SAN�,JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev:5M <br />