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FOR OFFICE USE:,. o-, R-ki <br /> APPLICATION FOR SANITATION Pa 'T <br /> -- ------------------------------------------------------ (Complete in Triplicate) Permit No. <br /> --------------- ------------------------ ---------------- Date Issued <br /> -------------------------------- -------------------------- This Permit Expires I Year From Date Issued <br /> �V j <br /> Application is hereby made to the San Joaquin Local District lor 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 /> o' __V_P67 S ---- ....... <br /> JOB ADDRESS/LOCATION N -------------------- #-----------.CENSUS TRACT - -------- <br /> ------------ <br /> ----------- -------------------Phone ------------------------------------ <br /> Owners Name __CHABA�J_F--------- <br /> Address ....... ------- ----------- City _jE ----------------------------- <br /> ----------- <br /> Contractor's Name _bW-114 ------------------------------------e�-------------A----------License # ---------------- -------- Phone ------------------- <br /> Installation will serve: Residence eApartme6i-H&-u—s6�[:]--Cdm—m--'erciaI �E]Trailer Court iE] I <br /> Motel F-1 Othe.r -------------------------------------------- <br /> Number of living units:___.___._. Number of bedrooM's '_:�3_____ ___Garbage Grinder WO_ Lot Size _ACRE46_4 -7—=--------- <br /> Water Supply: Public System and name�------------ r- _ <br /> -------------- ----- --------------------------------------------------------- --------Private <br /> r. <br /> Character of soil to a depth of 3 feet, Saiicl,'e SiltC] Clay ❑ Peat ❑ Sandy Loom E] Clay Loam F-1 <br /> Hardpan Ej`--,,..Adobe'E] Fill Material.-Nd_ If.yes,-t.ype ----------------------- <br /> (Plot plan, showing. size of-Jot, location' of system in relation to wells, buildings, etc. must; be placed on reverse side.) Rv <br /> tv <br /> NEW INSTALLATION:,, (No septic tank,or seepdge pit pdrmittb� if pUblic,sewerAs available within 200 feet,.) <br /> r t <br /> PACKAGE TREATMENT, 1 ] SEPTIC TAI I�K f Size------------------------------------------------ !Liquid Depth ----- ------------------- <br /> Capacity ------------......_1 Type -------------------- Material-------- ------------- No. ;Compartments ------------------ <br /> Distance, to-nearest: 1,Well ____________________________________Foundation ------------- -------- Prop. Line ---------------------- \4 <br /> LEACHING LINE No. of Lines '.:--------------------- Length of each line:------------------------_- Total Length ------------------------ <br /> 'D' Box _____A <br /> T pe Filter Material --------------------Depth Filter Material --------------------------------- <br /> i ------ y . <br /> Distance to nearest: Well ------------------------ Foundation ------------------------- Property Line -------- ----------- <br /> SEEPAGE PIT [ ] Depth .................... Diameter ---------------- Number ----------------- Rock Filled Yes [:j No C3 <br /> WaterjableDepth ------------------------------------------------Rock Size ------ ------------------------ <br /> Distahce to nearest: Well ----------------------------------------foundation -------- ---- Pro ,gine --------------_--_-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------_--- <br /> tq <br /> SepticTank�(Specify Requirements) ------------------------------------------------------------ ---I-------------------I----------------------.---' --------------------------- <br /> Disposal Field (Specify Requirements)-------CD -------F_XVST–)N_C--------P) 18_0y�---------- <br /> --- ------7 <br /> p — <br /> -----------140- -- <br /> -- -------OF -- <br /> ----- --2y----It------WI-P-E-- ------- 1___________________________ <br /> ------------------ ---- ---------- - <br /> -- --------------­----- <br /> --------------------- ------------------------ ------------------------------------------------- <br /> '=�(Draw existing and-required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance 'with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. korFie owner or licen- <br /> sed agents signature certifies tfie.1 dilowing-.=7 -===7 71__:!r <br /> "I certify that in the performar6 of m bie a Workma ompensat the-work-f r wh!c�jh*s permit.is issued, I shall not employ any person in such manner <br /> 0 <br /> as to bec of California." <br /> er <br /> Signec ................. Owner <br /> By ---------------- - - ------- --------- ---- ------------- --------------------------- Title --------:----------------------- ----- ----------------------- ----------- <br /> (If other than owner) N/ <br /> FOR DEPARTMENT USE ONLY <br /> 77���Zg <br /> APPLICATION ACCEPTED BY `------- ------------ ------------------------------------- DATE -----100---------- ..... <br /> BUI LDING-PERMIT-ISSUED ........... -, - __----DAT- ---- I . - <br /> - --------- <br /> --------------------------------- --------- -----------------ADDI ZONAL COMMENTS -----Vy T_7=_RM_j_1 <br /> -----W-04K.......... -, ; -% - - ------------------------------------------- <br /> ----- ------------------------------------------------------------- <br /> ------------- <br /> -------------------------------- ---- <br /> ---------------------------------------------------------------------------------------------------------- <br /> -------------- ------------------------- ------ Z. <br /> Final In ction b ---------------------- ---------- ---------------- <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H-.9 1-'68 Rev. 5M <br />