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2130 ` 2Cor <br /> FOR OF4CE USE: APPLICATION FbR SANITATION PERMIT <br /> -------------------------------------------------------- <br /> ^y - Permit No. 7�_"�US__. <br /> --------------------------------------------------------- � G- � � (Complete in Triplicate) � <br /> _________________________________________________________ This Permit ExpiregQ Year From Date Issued <br /> Date Issued f4__-30-7i <br /> Application is hereby made to the San Joaquin Local Health District for 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 /> i <br /> C, <br /> NSV�SZ <br /> ` i <br /> A - ------JOB ADDRESS/LOCATION - TR - <br /> --Owner's Name ------ ------ ---------- -- Ph e <br /> -� --- 1 lAddressCit - <br /> ---- <br /> Contractor's Name --------------- 1 --------------------------------------------------- -------.License # ------------------------- Phone ------------------------------ <br /> Installation will serve: Residence46Apartment House-E] Commercial []Trailer Court ;❑ <br /> / Motel ❑Other -------- ---------------------------------- <br /> Number <br /> --- ---------------------------- - <br /> Number of living units:_____!----- Number of bedrooms ------__....Garbage Grinder _' �_ __ Lot Size --_____6__-__ _ ��0 <br /> Water Supply: Public System and name -_ / ENv.C� % �' -'� cr,t 1--- Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat E] Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material _________ If yes,type _._-__________________-_-_ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is av Ila le within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK <br /> Liquid Depth ------- ..l____._.. <br /> q p <br /> Capacity 1, 6a Typ Material �� --j.`f"lEt-�f�o. Compartments '�... ..... <br /> Distance to nearest: Well __ -------------------_---Four tion J __ _______ Prop. Line _/_T._.:_....... <br /> --- �} <br /> LEACHING LINE [ ] No. of Lines-------------------- Length of each line---._. : :__-_-____-_5OWTotal Length -_ ________________ <br /> 'D' Box Type Filter MaterialDepthFilter Material -____-__ ! Z__.._ <br /> Distance Barest: Well ___��o___�--------- Foundation --- � *f`-------------- Property Line __ _ ................ <br /> SEEPAGE PIT [ ) Depth --------- ---------- Diameters7 <br /> ____________ Number _-__ ----------------------- Rock Filled Yes '❑ No C] <br /> Water Table Depth ----------- ---------------------------Rock Size ------.-----------_------. <br /> Distance to nearest: Well -.-____-_-___-______________________Foundation -------------------- Prop. Line ...................... (� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __________--__--_-_---__----_---__) p <br /> SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ---------------------------- --------------------------- <br /> DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- ............... <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 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 shall not employ any person in such manner <br /> as to befom -AY b* t, jo Woman's Compensation laws of California." <br /> Signed - � 1 -------------------------------------------- Owner <br /> � V <br /> BY = r -------------------------------------------------------- -------- ------ Title ------------------------------------ --- <br /> ------------------- <br /> (If other than owner) <br /> DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED BY __. 4 ------------------------ <br /> _1��" `________ �- _ •_ - __ ___ _ E. � ____.___. DATE _. <br /> BUILDINGPERMIT ISSUED ----------------------------------------- ------- ---------------f-- ----- -------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------------- ------------------ --- ---------------------------------------------------- --------------------------- <br /> -----------------------------------------------------------------------------------------------------------*----------------------- ---------------------------------------------- -------------------- <br /> --------------------------------------------------------------------------------------------------------r------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------------------------------------`-°--- - - -- ----- <br /> Final Inspection by: --------------------------------------------------------------------- ---- �----- -Date ----�c�--� ----------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />