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FOR E PS <br /> OFF C APPLICATION FOR SANITATION PERMIT Permit Ni ----------------- <br /> (Complete in Triplicate) <br /> Date issued <br /> --------- This Permit Expires I year From Date issued <br /> construct and install the work herein <br /> e les and Regulations: <br /> is-$ereb� made to tb' San Joaquin Local Health District for a permit to C <br /> Applicati 6pplication is made in compliance with County Ordinance No.' 549 and existing Ru <br /> described.11fk4L ----- -------- ----------- <br /> JOB <br /> TRACT <br /> --- ------------------ --- <br /> JOB ADDRESS/LOCATION ------ - ---- ------- ------------Phone-------------------------------- <br /> Owner's Name' -.--/1-/ T--AN <br /> - - ----------------------- ---------- --. city I j------- - -----iva------------------ -7 <br /> Address _.:3 2. -0 _1icen 1.se # __eV--- Phone <br /> _?------------------ <br /> Contractor's Name -- - -] Commercial,0Tral Court -0 <br /> Residence Apartment House f- <br /> Installation will serve. <br /> Motel 0 other .------------T-- - ------------------------ Lot Size ---------------------- <br /> e <br /> bedrooms --A- --,Garbage Grind ;r/Vd----- <br /> Number of living units:..-/-_.--- Number of -----Private <br /> I1� and name ------------------------------------------------------------- 11 <br /> Water Supply: it Public System 0 Sand'] Silt M Clay F1 Peat 0 Sandy Loom 0 Clay Loom 0! <br /> Character of soil to a depth of 3 feet:Hardpan ❑ Adobe J4 Fill Material ------------ If yes,type ---------------------------- <br /> - <br /> must e placeon reverse side.) <br /> location relation <br /> (plot plan, sho' Ing size of lot, I ion of system in to wells, buildings, etc permitted if public sewer is available witbfeethin 200 J <br /> NEW INSTALLATION: (No septic tank or seepage pit perm ----------- --- ------------I--------- <br /> 4 <br /> Size---------------------------- <br /> Liquid Depth - <br /> PACKAGE TREATMENTSEPTIC TANK:[ I--. , - .—, Compartments- ------ --------------- <br /> Capacity -------------------- Type --------------- ---- Material------------ ---------- No. <br /> Distance to nearest-, Well ------------ --------- ----------Foundation ---------------------- Prop. Line ------------- -------- <br /> Total Length-:-- ------------------- <br /> p. ---------- Length -df each line--------------------- <br /> -------------- <br /> LEACHING LIN No. of Lines'D' Box ---- ------ Type Filter Material -------- ---------------------Depth Filter Material ------------------------------ --------•-7 <br /> --------------- Property Line -------:---:------------ <br /> -- <br /> Distance to nearest: Well ---=---------------`-- Foundation Rock Filled yes C] No .0 p_ <br /> SEEPAGE PIT: Depth --------- ---------- Diameter ---------------- Number ----- -------------- <br /> --------Rock Size -------------------------------- <br /> Water Table Depth --------------- --------- ------------ <br /> Distance to nearest: Well ------------------ <br /> -----------------------Foundation -------------------- Prop. Line <br /> Date ------------------------- --------1 �o <br /> REPAIR/ADDITION(Prey. Sanitation Perrnit# ------------------------------------- ------ --- ---------------- -----------11---------------------------- <br /> ii <br /> Septic Tank (Specify Requirementsl ------------ <br /> --------------------------------------------------------------------- ---- - -- ----- --- <br /> Disposal Field I (Specify Requirements) ---- .......llo-ell"_1 19A) "g <br /> ---------- ----------- -------------------------------------------------------------------------------------------------------- ----------------------------------- <br /> --------------- ------------ ----------- ------------------ ---------------------------------------------- <br /> - ----- ------------------------------------------------- <br /> -------- ---- <br /> -------------- --I-------1 -------------------- ----------Draw-existing and required addition on reverse side) accordance with Son Joaquin <br /> '1ify that I have prepared this application and that the r work will be done in <br /> hereby cart oaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following-. for which this permit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work <br /> :Ij CompensationCalifornia."laws of Californ <br /> as to become su 'a t W rkman's.Compens Owner <br /> Signed -- ------ --- ------- ------ <br /> ------------------------------------- <br /> - ---------------------- <br /> T <br /> - - - - - ---- ---------- <br /> By ------- - -other-- - - than__owner)--------------------------- ------------------------ Tit ----------------- ------------ ------------------ <br /> FOR DEPARTMENT USE ONLY <br /> DAT <br /> Z <br /> A PLICATI N ACCEPTED BY ------ ------ DATE -- ------------------------------------ <br /> - 0 -7- ------------------------------------------- -------------- --- -------- <br /> BUILDING PERMIT ISSUED ------------------------- ------------ -----------0------ --------- <br /> - ------------------------------------------- ----------- -- ----- - <br /> ADDITIONAL CO?tAENTS ----------- <br /> ------------ -- -------- <br /> -- ---------------- ---- ----------------------------------------------------------------- <br /> -- ---- -- ------ --2 <br /> ---------------------------------------------------- <br /> -- - -------- <br /> ----------- ------- ---- -- <br /> ----- --------- --- --------- <br /> --- ------ -- ---------- <br /> Date <br /> -------------------L ---- --- <br /> Final Ins pe tion by - ------ to <br /> �� <br /> 4 J01 N JOA LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5mi <br />