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n %Xeo /co%K <br /> FOR OFFICE USE: 7 <br /> APPLICATION FOR SANITATION PERMIT L. <br /> AP <br /> }. .... ............................. <br /> . :a.. . .. ., �j... <br /> {Con+ ete in Tdplicatel Permit No. .y'1c <br /> j Date Issued ..............:..... <br /> .......... ....................................:...•.--• This Permit Expires 1 Yeah From Date Issued <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 OYdinonce No. 549 and existing Rules and Regulotions: <br /> b <br /> .. �... ... ... ....._ ....., .: CI:N�us TRACT .... ..... <br /> JOB ADDRESS/LOCATI �.. �':.... <br /> Owners Name ....._.... -- ---- - ........ _-- ------------------ -•--- Phone)..L.7..VQ........... <br /> ate.._...,city Address ................--------�� --E..... - •--. .. ... ..... . ........ <br /> ----............. <br /> ................_. _..--------------- <br /> Contractor's Name ----------- ..............4........License# Phone ------ <br /> Installation will serve: Residence p Apartment House C] Commercial OTrailer Court 0 <br /> lotehCj.Other <br /> Number of livingFnits:_.__ _: Number of bedrooms . 1�Garbage Grinder ---------- Lot Size ........ ......... ...... <br /> ___._:_ <br /> Water Supply: Public System a�`narne�'� . . _=-- __.......................:.. Private ` s <br /> Choracter:of soil to a de th-of 3 feel: Sand < <br /> p ` q� x� Silt Clay 0 Peat❑ Sandy-Loam_0 -Clay Loam_Q <br /> a� R�.Hardpan AdoILFIN 1f yes,type ....... <br /> (Plot plan, showing size of lat Location of system in relatiant o we11s bufldin�s, etc. must be placed on reversefslde.) <br /> M <br /> 1 <br /> NEW INSTALLATION: (No. nk or seepage pit permitted=&,po ublic-sewer'Is available wifMn-200 feet,) <br /> sept c tank r' <br /> PACKAGE TREATMENT SI:FTIGTANK S'ze-..:. :t� j Li uid De th . .��......... <br /> € l Xi q p <br /> Capacity - ...-- _ Type --------- ------- MaterJii1..4 ..�K :r:.:=No:s-Compartments ...........'� <br /> Distancel4olnearest: Well ,l O__...:#`._. Foundation /.Q... Prop. Line _ 3T............. <br /> .._._. ....- <br /> Li=ACHING EINE No. of tines ......... -------- Length of-Poch Iine'_ _ � t� r....... Total Length .... ............. <br /> V Bax ....--�fype Filter Material ... . ..Depth Filter Material ...... ... .......................... <br /> t <br /> Distance to' earest: Well ...100.1 f' Foundation ... ._ 0.f--it Property Line -r5................ <br /> f <br /> SEEPAGE PIT f Depth � � ': ....: l�iarneter `�... Number ....... .... .. Filled'. Yes J6 No 0 <br /> Water Table Depth ................................................Rock Size . .. ............. <br /> ?-...... <br /> Distance to nearest: Well .__._... _ ...JF'..............Foundation ...fel.. '.. Prop. Line .. .......... <br /> REPAIR/ADDITION(Prev. Sanitation�Permit } <br /> ......�::...........•--=•-•-�--•:�.�.�.Date ...:....._......--••---......----- <br /> Septic Tank (Specify Requirements). ... ..........­_.......e....................................... --•----•--•-----------------------•--•-•-••----......... <br /> Disposal Field (Specify Requirements) ............................................................. ........................................................................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that l 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 San Joaquin Local Health:District. Home owner or liven- <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 ----------- ------ . _... ----- - ---•-----------• ................... Owner <br /> By - -- --- - Title ._.. <br /> ................ ..................... <br /> (If of t an owner) <br /> FOR DEPARTMENT, USE ONLY <br /> APPLICATION ACCEPTED BY ------------------- ' ---------------------------------------------,DATE _...! --/.. ...... <br /> BUILDING PERMIT ISSUED / •- • - ----.•,_ .- ._. I DATE%, <br /> ...... <br /> ADDITIONAL COMMENTS ..-.. 3/1 .?j it?'1'` t__. ... .G! sahc------------- <br /> ------------------------- <br /> Tff a- �r Q <br /> : ' <br /> �c <br /> ...... .............. � �a�' _. ._.__._.. ........ <br /> - <br /> Final Inspection by: ......_.. = .................. ---------------------Date ....2- ..G �r........_.._...._. <br /> EH 13 2h 1--68 liev. 5M SAN JOAQUIN.LOCAL HEALTH DISTRICT 8/74 3M <br />