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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No� <br /> / / 1 <br /> + * (Complete in Triplicate) <br /> O (This Per rrnt it Expires 1 Year From Date Issued <br /> Date Issued <br /> _ <br /> ______________ .___-_.-_ _ , <br /> ....__..._.__...__...... --- s~ lT <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 / m / <br /> ..... ...... ------------------:...._CENSUS TRACT ------.-----------•-•--- <br /> .. ..�� a <br /> Owner's Name �r ,..f.....: 1/. 1��!.. 6d..------. ---..................................Phone.-5/ T-3_y ?/ <br /> 3 <br /> � l� J .. . ' ... -- TT...-------. <br /> City <br /> Address .__.._ _...-•-... ..._�--- `3 YJi <br /> ---------- <br /> Contractor's Name .......... <br /> Installation will serve: Resident'`� I E-)ApartmentHouse fl Commercial oTrailer Court ;l] <br /> Motel OtherC f?Ca --- vldz 75�;�t/ <br /> Number of living units------------- Number of'bedrooms ------------Garbage Grinder ------------ Lot Size -----.--------.---------.------------------- <br /> Water Supply: Public System and name ---------------------------- -------------------•---•--.............................. Private (� <br /> Character of soil to a depth of 3 feet: I 5Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom.E3 <br /> Hardpan p 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 /> +., �� - <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if public sew✓er is available within 200 feet,) <br /> PACKAGE TREATMENT '[ ] SEPTIC TANK �} Size.'�i/ X-S�'/�.--• f'�....... - Liquid Depth __,'y------------------ <br /> ty-j.M_ _ T 'dhe`045/ ater'al_C40A --.__ No. Compartments ..._ '........._. <br /> Capaci j Ype. .. ...........• <br /> Distance to nearest: Well ............ <br /> ..__. Total Len <br /> LEACHING LINE No. of Lines «_ _____ . "`Length of h cine..` .0 -..-.- Length ......... <br /> _/7 <br /> 'D' Box __/ Type Filter,Material`Sf: �� Depth Filter Material __l-- ............................... <br /> r 77!Y / ,� <br /> Distance t/o,nearest!'Wel l/Q�-r=.f---- Q <br /> Foundation ! e..... ---- Property Line4. <br /> . - _-,� IA --- <br /> SEEPAGE PIT ,. Depth ../_..��_;....... Diameter - Nurftber ---------- --------------- Rock Filled Yes No 0pO <br /> Water Table Depth ....._�.�------ . - -Rock Size -���.,?1�. -.-------.- ° <br /> •Distance to nearest: Well/-,f?-4............................Foundation ------. Prop. Line . ._...a;_�I./AI <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- �- Date ------------ ------------ <br /> Septic Tank (Specify Requirements) -........................ --------------------------------------------------------_...-•----•-------.-•�_..-_ --••------------- R . <br /> Disposal Field (Specify Requirements) ---------• .......... ---------- -------- ------•-----•--••--------•------- <br /> ................--- ................•----.--.......-•-- ................--------- ----- .. <br /> ------ ..................... <br /> .' (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and-fhat the work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and'Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: i <br /> "I certify that in the performance of,the work for which this permit is issued, I shall not employ any person lin such manner <br /> as to became subject to War an�_Compensatmn laws of California." �- <br /> Signed . C k- f-__-f.-E'. .._..-. .. e:------ Owner <br /> _ . ... <br /> By ----------------------- - l�f <br /> - Title ...._. -------- <br /> if other than rl <br /> FOR DEPAttTMENT USE ONLY '! <br /> APPLICATION ACCEPTED BY..... ------ -Q- - ---............................................................... DATE ---- / j -------•---- -- - <br /> BUILDING PERMIT ISSUED ----...... " ... --D .......................................... <br /> ADDITIONAL COMMENTS --- moo" ----------- <br /> - ___ --------------� I....... <br /> Final Inspection by: ----­-­-------­--------­----------- - ---......-------- --------......_._Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />