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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> i <br /> ............................... --(Complete in Tri piicate).. Permit No _ -_----_------- <br /> ..... i.........-•--•-.: .. <br /> _.- <br /> i I r Irhis Permit Expires-t Year i"rotrt Da Date Issued . . .s"_ <br /> ...... ...................:.:: ....... p h>Issasd <br /> Application'is`hereby' made to the Scin'Joaquin';local Health,'Distnct,for�a permit to-, construct and install the work herein <br /> described:This application is made, in.'compliance with'County; naro. <br /> Ordiice N549,andiexisting. Rules and Regulations: <br /> Ne <br /> , • � - 1. � . = i � t .. f <br /> JOB ADDRESS/LO�CATION:..__ _�.�- y -- ........................... .. ............CENSUS TRACT .......................... <br /> fOwner.'s _Name�J`C�w4.,, Ga ... `__ -�:� Phne _' ..................AddressQ .� ..�-�- 51......� ` . t �/ �/- City �._... ­-­----------- <br /> actor's <br /> - � <br /> Contractor s Name . � � --��-� �F l�....r license # �r s5eZ^_ Phone ._ <br /> installation will serve: } Residence[Apartment House fl Commercial OTraller Court 0 <br /> Motei ❑Other' -- =-•--- <br /> s P - . <br /> Number of 'living units:-:_- r` ....Number of:bed ..Garbage Grinder'. Lot Size 1. <br /> r e ..........:.. <br /> Water:Supply.-Public' System and'name'..........*.......:......:...... .............. : .......-_ .. ........... .Private <br /> .. + <br /> Character of soil to a depth'of <br /> 3-feet Sand[] Slit Q Clay- Peat Sandy Loam 0' Clay Loam,O `�`►,� <br /> Hardpan.[ Adore tl Fill Material ............If yea,type:.............. ............. <br /> (Plot plan," showing size of lot, location of system in relation to wells, buildlhg' s, etc. must be placed on .reverse side. <br /> NEW INSTALLATION: (Nc septic tank`or see ager pit fiertanitted if public]sewer is.available'within 200 feet,)" <br /> PACKAGETREATMENT., SiPT Size -=.e .:._rt�:.'S'.�----- liquid Depth ......V............ <br /> :- <br /> 1 i ? X1i a: Material , <br /> Capacity; 2 ?._--.. Type 1 ?. n��. ;.. No. Compartments .�. .. .. <br /> ' µ Distance to nearest: Well .."`_Foundation _....�.f7. ?`� . Prop. Line;�_> . <br /> LEACHING LINE ( No; o#lines ._-� .......... Length', f e d n x i? �- :... Total' length:'. f�--. <br /> a . <br /> l z r 'b Box ..: Type Filter Material ..�� ` ..Depth .Filter Material ..... . . ..1. <br /> r Distance to nearest:'Well �?. Foundation ... .. .g Pro erty line �� ..... <br /> SEEPAGE PIT Depth :.. Diameter r.: ...../!.. . 4 <br /> [ p Numbor ...... ... Rock Filled Yea No Q <br /> F Water Table ©eptli' : i .--�. ° ._ .Rock Size ...._ /' <br /> � .... ......... <br /> Distance to nearest: Well F a Foundation L -._ Prop lane <br /> ---- <br /> v -SanitationPermit-{PeREPAIR/ADDITION ............... <br /> 7:Requiremtents! i .... Da <br /> (Specify ... r ... ----` .. i ---_.. .-- °.�.. <br /> .......... <br /> (Septic Tank <br /> t Disposal Field (Specify Requirements), __-'- - -- ---------- - ---------- - ----:.....---•-•-•- <br /> i -----• " <br /> -•------•---------- -•-------•---- <br /> 1 - 1a ................................................................. ..... <br /> S ( (Drdw existin aiid required addition on.reverse side) i + . <br /> hereby certify that 1.have prepared-this.appiiiation.and�that ath wotfc°will be•done rein accordance�with San Joaquin <br /> County Ordinances; State Laws, and Rules and ;Regiitations of the'San Joaquin Local Health:District.-Home owner or licen= <br /> sed agents signature certifies the fallowing: g_ I. .�„ ' . _. k. I r <br /> "i;certify that in the: performance of the work for which this permit'is issued;1 shirll not ernplay any person in such manner <br /> as to become subieit toWo*km <br /> mon's Compensation laws of Califarnla." <br /> ' <br /> E l t <br /> F <br /> 1 �,�� _ <br /> By ;.-..... L ----'-. . •-•-- Jit � f i ...... . .. ..... ............ <br /> i if otlier than owner). <A. r r' le ' 1 <br /> ;rFOR,DEPARTMENT. USE ONLY <br /> APPLICATION ACCEPTED. BY.----!- - l ` = ------ -." DATEZl = ' � ' = <br /> - <br /> BUILDING PERMIT ISSUED . •j •-• --- ------------------------------------ - -- --------------DATE ---------------••- ------------ ........ <br /> ADDITIONAL COMMENTS---------------- ' <br /> -••------------ ---- --- •----•_...---•--••.................. ...... ..................... ... .. . .. .............................................. ..... <br /> ---------------------------------------...-----..._..----------- <br /> _ kc�Y' <br /> Final Inspection b-"•----'---=------ �� - - - - ............... .......... <br /> Py: - ----------- ..-.---------- ---------•------•--- -------•..--------- • ----• Date S Y, <br /> iii 1.3 2 1-68 Bern. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7!i 3M <br />