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APPl1CATlOf� FOSANITATION PERMIT <br /> FOR OFFK�E USE: Permit No. <br />- , . .. <br /> --------' <br /> --------- (Complete in Triplicate) 3 { 3 Z <br /> . Date issue .---- ��--�-------- <br /> ------------ <br /> ------- <br /> This Permit Expires 1 Year From ate ssue <br /> ------- <br /> fiance with County Ordinance NP-'549 and-existing Rules and, Regulations: <br /> A licafiion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> pP application is made in comp _ <br /> described. This aPP \` .— . -:CE t -- ---------- <br /> P4 f - = :,-- NSUS TRACT <br /> w _..�_. / <br /> o�#_lam_---I Z d 9' <br /> JOB ADDRESS/LOCATION .-------- . x i --------Phone.'f.7_$_�---1 ---- <br /> L '- -- .;Ge,)-TO/V . <br /> Owner's. Name _L9: City -----�-- ------- <br /> Address <br /> / '_ _ ,S- U L ---------------------- <br /> - ----------------------- <br /> -'License # --------------- <br /> Phone <br /> Contractor's Name ----------------------- + <br /> Residence � Apartment House❑,Commercial❑Trailer'Court i <br /> A Garbi <br /> I Motel ❑Other ----- ---- --------------------- - <br /> - age Grinder _----------- Lot Size s.� , <br /> Number of living units.-.-I-------- Number of bedrooms _ -____-- iva ❑ <br /> _ �Tom_ ------ z ---------- --------------------------- <br /> Water <br /> ----- - -- <br /> Pr <br /> ' e <br /> Water Supply: Public System and name __--w .peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Character of soil to a depth of 3 feet. Sand' Silt❑ ClaY ❑ <br /> -sa <br /> Hardpan <br /> Adobe'❑ Fill Material _,__-- 1f yes, type <br /> E] <br /> i etc.,lnLst be�p{aced -on-reverse side.} <br /> (plot plan, showing size of lot, location of system in relation to wells, buildings, 6 <br /> NEW INSTALLATION: {No septic tank or seepage pit permuted if <br /> public sewer is avail-able-within 200 fee#,) <br /> Size ---- Liquid Depth <br /> SEPTIC TANK'[ } :---- .' i _,. <br /> PACKAGE TREATMENT { 7 ;,No. Compartments -2-----•--•--•---- <br /> YP 6A Material_C�t-o-��= ' V � 7-, <br /> Capacity1�p0 Grt}- T e �p_�-� <br /> T 1� :_• Pro Line -.COQ <br /> r <br /> Distance j.to nearest: Well __� -T - == Fovn8ati ,n �p-- =------ P' d <br /> i �� `-r-------------- Total Len .4 o - - --------- <br /> _ Length of each .line-- -- �:,c <br /> ' LEACHING LINE [ ] No. of Lines -2------------------- � <br /> - <br /> r� A ,7 <br /> - Type Filter Mate Line Material - -- -------------- <br /> 'D' Box�__j------ Yp - s <br /> I - L e�5_ Property line ---- <br /> Z4$ Founda#ion �_--- ---/-�- <br /> Distancei,to nearest: Well )404)---�- o ` 4 '---Rock <br /> Filled ;Yes-,g No <br /> r <br /> Number __:��`i' =---------De <br /> :Depth _y.��� Diameter r _ -, .` r <br /> SEEPAGE PIT MP P 1 ` =-----R cic size Z- -------------- <br /> Water. <br /> --Water. Table Depth ----------------------------------- <br /> --- --- ------------- <br /> . . Prop. Line -. <br /> ------ - -- Foundation <br /> , <br /> Distance to nearest: a Da <br /> ' fie -------------,-- <br /> REPAIR/ADDITION(Prey. Sanitation Permit <br /> ------------ <br /> Septic Tank {specify Requirements} _________________ _ ------------------------------------ <br /> -------------- <br /> 1. <br /> Disposal Field lSPY <br /> ecif Requirements --"--------`-------- <br /> ------------------------- <br /> " <br /> ---- <br /> ----------------------------------------------- y ---------------------------- <br /> 1 <br /> _______________ ______-_ ___._ -_ ----__-__-__-__--_--_-__-.____--__-__-__-________-__-____________-__.__-______-.____-_____-_____-__ <br /> ---------------- -- [Draw existing and required add•+tion on reverse side} <br /> ilication and that the work will be done in accordance with San .loaquin <br /> 1 hereby certify that I have prepared this app <br /> Count Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen- <br /> Y <br /> F <br /> sed agents signature certifies the following: erson in such manner <br /> '-1:shall not emp oy anY p <br /> i "I certify that in the performance of the work for which this permit is issued, <br /> as to be subiect to W kman's Go pen3ati 1 ws af,i�afifornia." <br /> ------------------ <br /> ------ ' ''�'ner <br /> IN <br /> Signed - ---- <br /> - <br /> Tifile -- ---- �� <br /> - ---- ------ - <br /> (lf other than owner) _ , - e <br /> ----------- ----- <br /> I FOR DEPARTMENT USE ONLY . <br /> '. ----- ---------•- --------- DATE --- -� --- • - <br /> APPLICAT10N ACCEPTED BY ---- <br /> - -- _DATE ---------------- ---------- ----- ----- - <br /> - ------=---- <br /> BUILDWG'PERMIT ISSUED --- --- - <br /> ADDITIONAL COMMENTS ------------------------------ ------------------------------- --------- ------------ ---- <br /> t` - --------------------- <br /> ------------------- ------------- ----- -- - � �4e <br /> -- -- <br /> - -- - - ------ - - - Date -- - <br /> - --- - - ------ <br /> r <br /> Final Inspection by: -t -- -------------- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> V u 0 1-'68 Rev. 5M "�` <br />