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1 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------------------------------------------- -- <br /> 7.s_ _ _1� <br /> Permit No. .._ <br /> (Comple?e in Triplicate) i <br /> --------------------------------------------------------- <br /> fThis Permit Expires 1 Year From Date Issued Date Issued ----q_____5:_ <br /> Application is hereby made to the San Joaquin Local Health District for 'a per 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 --------___JG-L.- - ----- ------ ✓ --� --U`------ - Sca-{.apt-------CENSUS TRACT -._ <br /> ---------------------- <br /> Owner's Nome `! ra.7__ C' -----------------------------------------Phone - ------ <br /> ----------------- II //� / <br /> Address ---------------- -------fl ��--- ----5" 1;k r'l-----�'---r---.--. City ----- 54s A!------------------ <br /> Contractor's Name ------------ ------S".f f'------------- -----------------------=-------.License # -----r ------ Phone -------- -------- <br /> -Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court <br /> Motel ❑ Other ------------------------------------------- yy/� <br /> Number of living units:... ------- Number of bedrooms -----r2 ---Garbage Grinder ._N-C?__-_ Lot Size ----- ------------------- <br /> Water Supply: Public System and name ---------We//------------------------------------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam .X Clay Loam ❑ <br /> Hardpan Adobe'❑ Fill Material --------- -- If yes,type ----_.-__---___-_._-____- <br /> (Plot plan, showing size of lot, location of system in relation to v,iells, buildings, .etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] <br /> � rr <br /> PACKAGE TREATMENT [ ] SEPTIC TANK nn Size----------- --a©/� _��_.a -.------------ Liquid Depth ._.y__--_---_--_ <br /> P Y e as" - Type _f��-_��-�-- Material-_-01��f!"� c No. Compartments -----�--------- <br /> Ca acit ---- <br /> � t � <br /> Distance to nearest. Well ---------�Q©-----------------Foundation ------3S--------- Prop. Line -----_--_ <br /> LEACHING LINE No. of Lines / <br /> ] r�_ ---- Length of each line-G------�C.1_ _- -'- Total Length --f..r4--------------- j <br /> 'D' Box ----✓_ Type Filter Materia C'r�t=�_A-CTepth Filter Material ------- - --------------------�_-_----.- +b� <br /> Distance to nearest: Well ------ ---------- Foundation >_ ---------- Property Line ------------- J <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter --- Number ---------------------------- Rock Filled Yes ❑ No ❑ N <br /> WaterTable Depth -------------------- -------------------------- Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------_---__-_____--__Foundation --------------- -- Prop. Line ---------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------nDate -----------------------------------1 . <br /> Septic Tank (Specify Requirements) ------------------------------- -----------`---- ----------------------------- ,.---------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------- ----------- -----------------------------------------------------.---- 7 <br /> S <br /> ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------_------------------------ <br /> � <br /> -------------------------------------------.--------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 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 San 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 shalt not employ any person in such manner <br /> as to become blect to W cman's Compensation laws of California." <br /> Signed Y r ----------------------------------------- Owner <br /> BY ------------------------------------------------------------------------------------------------------- Title .---------------= <br /> (If other than owner) <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- - - ------------------------------------------------ ------- ------------- DATE ------ `{ 7 ---------------- <br /> BUILDING PERMIT ISSUED - -------- ------ ----- ------ ----------------------- -- DATE -------- ---------------------------------- <br /> ADDITIONAL COMMENTS --------- 3---- -- z'^"5 - - -------------------------------------------------- <br /> -- V <br /> ---- --- ---------------------------------------------- ------ ---- ------------- ---------------------------------- -- <br /> ---- ----- ----------- -----------------`M -------•------- <br /> 7 .,.... <br /> Final Inspection by ------ -- ---- - --- --------------------- Date <br /> SAN OAQUIN LOCAL, HEALTH DISTRICT <br /> Y <br /> E. H. 9 1 `68 Rev. 5M <br />