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FOR OFFICE USE: { <br /> `. APPLICATION FOR SANITATION PERMIT 7S_1,3,1 <br /> -------------- Permit No ----------------- <br /> (Complete in Triplicate) <br /> i ---------=----------_ _ ------------------ <br /> t ____ __-_ ------------------------- Date Issued --- '.3--7--- <br /> ------- ------ This Permit Expires 1 Year From Date Issued `*, <br /> c � <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 /> JOB ADDRESS/LOCATION .-- --f�_ � __-- a•------/ f�/� 5�1 -----J - -------------------CENSUS TRACT -,---------_r's <br /> Owner's Name -------- -------- ------------------------------------------------ <br /> -------Phone ------------------------------------ <br /> Address <br /> ----3?'---- -------3 -- <br /> Address ---------------T /VC------------------------------------------------------ --------------- . City - Yf G -------------------- <br /> Contractor's Name .-_ _1 If f' -----"-----��adl----------------------------1-cense # 46, 6__ Phone <br /> Installation will serve: �'I Residence 'Apartment House-[] Commercial :❑Trailer Court ',❑ <br /> 4 � Motel ❑Other ------------------------------------------ <br /> ` Number of living units.___![/_-____ Number of bedrooms e;-------Garbage Grinder .---------- Lot Size _________________________________--____.-.- <br /> Water Supply: Public System and name ------------------------------------------ -------------------------------------------------------------------Private kJ <br /> Character of soil to a depth of 3 feet: Sand'[:] Si It Clay ❑ Peat❑ Sandy Loam IX Clay Loam '[7] <br /> Hardpan E] Adobe , - Fill Material .----------_ If yes,type ---------------------- - <br /> t , <br /> (Plot plan, showing size of lot, location of system relation to wells, buildings, .etc. must be placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank or seep a pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [`I] SEPTIC TANK [ Size------------------------------------------------ Liquid Depth --------------- r <br /> Ci b d CA a itY -�-.----- _ 'TYPeP/O__�f$7 Material____ ----- No. Compartments A------------_-_ S <br /> -stance to nearest: Well ---- Foundation --______---- Prop. Line ------------------ V1 <br /> LEACHING LINE No. of Lines ------�.______________ Length of each line_/�_O--____-.------ Total Length �O b <br /> 1 e �! <br /> D' Box ---k----- Type Filter Material ��-�__tQoefi-.Depth Filter Material ------A�!_____......______-------I...... V) <br /> D <br /> istance to nearest: Well ___ ------- <br /> Foundation ------------ Property Line. ------------------- <br /> SEEPAGE PIT [ ] • Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 9 <br /> Water Table Depth ------------------------------------------------Rock Size ---------------------------- -- <br /> - <br /> N <br /> stance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------_.----_------. � <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------11 <br /> Septic Tank (Specify Requirements) --------------- --- ------------------- <br /> --------------------------------- -------------------------------------••--------------------------- <br /> Disposal Field (Specify, Requirements) ---------------------------------------------------- ------------------------------------------------=------------------------------- <br /> ------------------- ------------------------------------------------------------------------------------- -------------------------------------- <br /> --------------------------------------------------- -------------------------------------- <br /> I� (Draw existing and required addition'onreverse-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 Sar► 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 -_.-,96—ir.Al /f4 !! f---J(---�;Ipof----------------------- -------------------- Owner <br /> BYl ----- --------- Title ------------------------------------ ----------------------------------- <br /> othert an owner) A ' <br /> r FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED']BY # ' `----------------------------------------------------------------------- -- DATE ----- -- --'--------- <br /> BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------------------------------DATE <br /> ------------------------------------------- <br /> ADDITIONAL COMMENTS -4----------------------------------- -- ------ ------------------------------------------------------------------------------------------------ <br /> --------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> ------------------- ------------ <br /> ii <br /> ------------------ <br /> -- -- ----------- <br /> ---- - <br /> Final lnspection ` ----------------Date ---- -....- --- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />