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FOR OFFICE USE: `APPLICATION FOR SANITATION PERMIT <br /> Permit No. .__��--<•7"-6 <br />---------- ------------ --------------------------------- (Complete in Triplicate) <br /> ----------------------- Date I ssued _.✓__ /-� <br />-------- <br /> This Permit Expires II Year From Dote Issued <br /> ------------------------- <br /> Application is hereby <br /> tnes the Son <br /> District <br /> ninstall <br /> rein. <br /> described. This application is made compliance wih County Ordinance No. 549 and exstngRulesand,Regulations. <br /> JOB ADDRESS/LOCATION ------------------------ ' CENSUS Ti�ACT ------------------.------- <br /> -- - ----------------------------------------------------- <br /> jF!� -- -- -Phone +S <br /> Owner's Name ....rf�flR1n�T--�----��---- �--------- --ra'�'---------•-----------.----------------- .. <br /> -- <br /> "V Address ---� 73 ---------- . Cit ' <br /> Contractor's Name - License #_---=_.::-,-------------- Phone <br /> - <br /> }� Installation will serve: Residence''Apartment House-,0 Commercial ❑Trailer�Court l❑ <br /> Y �• <br /> ra• �l. - � Motel ❑Other ------------------------------------I/.... --' � <br /> Number of living units:._--___._ Number of bedrooms __ ---_Garbage-Grinde.,c.r:-------- Lot Size �-�..��� - � <br /> W <br /> t c'---------- e- r Private ❑ <br /> Water Supply:,Public System and name ��^.�°:=�----•--� ------ -----------------------------------------.------1- <br /> i •� <br /> Character of soil to a"depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe F-] Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size-of lot, location of system in relation to wens, buildings, a#c, must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit pgrmitted if public sewer is available within 200 feet,) J <br /> L� S'.C.9Li uid Depth ------- <br /> PACKAGE TREATMENT [ I SEPTIC TANK PQ Size____ _ _ --__ -------- q p <br /> Ca acit TYPe � Material NO. compartments _____ ...---------- S <br /> Distance to nearest: W II __ _p------------------------•Foundation -_, �----------- Prop. Line __ Jul--------- <br /> _ V � <br /> LEACHING LINE [X} No. of Lines _ _- '------------ Length of ear li _-C�- --_---- Total Length --- - --.---------• <br /> D' Box --f�Type Filter Materi�`--------------Dep}h Filter Material _. -Q-------------------- ------ In <br /> f. . p ty <br /> SEEPAGE PIT E-+-- Depth --_{ ----- -------- Diameter ---------------- Number ---------------- :..___ Rack Filled Yes [I N° �❑� <br /> Water Table Depth ------------------Rock Size'--- '-------- ------------ f <br /> V, <br /> ` Foundation ---------------- -Prop. Line �q <br /> Distance to nearest: Well ------------------------------ <br /> t Date ---------- -------1._2 <br /> REPAIR/ADDITION(Preva Sanitation' Permit# _______.___------------------------ <br /> Septic Tank (Specify Requirements) ---------------------- ------------------- ------ -------------------: ----- <br /> Disposal Field (Specify Requirements) -------------- --------------------`--------------------------- <br /> -------------------------------------------------------------- <br /> i ----------------------- <br /> --------------------------------- <br /> ----------------------- <br /> ! - ------------- <br /> -----------------------------------------------:---------- - <br /> ----------------------- - <br /> ------------- --------prepare <br /> ----- application(Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have re aced this a lication 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 folio : <br /> "I certify th?ijoce of a ork for which this permit is issued, I shall not employ any person in such manner <br /> as to bec an's`C laws of California." <br /> Signed Owner <br /> By - ------------- ------------ --- ---------------- ----- ------------------------ <br /> Title ------------------ <br /> (If other than owner) <br /> FOR DEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED BY _ --- DATE _--- 0----. --'� '--`- <br /> - - <br /> E BUILDING PERMIT ISSUED -- ---- DATE <br /> ADDITIONAL COMMENTS ----------------------------------------- ----------- ---------------------- ------- <br /> -------------------------------------------------------------------- <br /> -_ ------------Date ------ ----- ---- ---- <br /> Final Inspection by: ----------- -------------- - <br /> SAN JOAQUIN LOCA HC <br /> EALTH DISTRI <br /> /C/) /6 7Z- .00 <br /> 'Y10 <br /> nn���� tirf.�ah 1�'7/• � u /e <br /> E. H. 9 1-'68 Rev. 5M - d k <br />