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FOR OFFICE USE: ` APPLICATION FOR SANITATION, PERMIT <br /> �. Permit <br /> ---------------------------------- -------------------y ;r (Complete in Triplicate) <br /> -------------------------------------------- <br /> ----__-."--,___ -This Permit Expires 1 Year From Date Issued Date Issuedi/,;7--/, �_(�_-"_ <br /> --------------------- ------------ - ----- -------------- <br /> Application is hereby made to the San Joaquin Local Health District fora 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 /> f ----:----CENSUS TR T ----------- <br /> JOB ADDRESS/LOCATION __1 9 �l D------ �y j <br /> llemoi$ -------Phone <br /> Owner's Name _ <br /> ------ _1 y _ <br /> �. ------------------------ _ ___-_ ___ <br /> f� ___________________________ City _ Irl <br /> Address -6P--/ - 1l 6 r <br /> �-} License # -7_- - Phone <br /> Contractor's Name �=Y 1-----C" �1 6-e <br /> Installation will serve: Residence '.Apartment House❑ Commercial:❑Trailer Court ;❑ <br /> Motel ❑Other -----------------------------------d <br /> Number of living units_____________ Number of bedrooms __.!-----Garbage Grinder ------------ Lot Size- -------------------------------------------- <br /> � Private ❑ <br /> Water Supply: Public System and name ------------------------------------------------- - --------------------- <br /> •--------------- <br /> Character of soil to a depth of 3 feet: Sand'{ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ " Clay Loam ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ----------_----------------- <br /> (Plot plan, showing sizeof lot, location of system in relation buildings, etc. must be placed on reverse side.)'to wells, W <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> SEPTIC TANK Liquid Depth -•---- <br /> \ <br /> PACKAGE TREATMENT [ ] � ] Size-------------------- --------- -------- -- - q P <br /> "r _ Material______________________ No. Compartments __________ _ <br /> p <br /> Capacity ----------------- TYe ; <br /> Distance to nearest: Well ----i------------------------------Foundation ---------------------- Prop. Line -------------=-,------ <br /> -i__-- Len5th of each line------ <br /> 14t <br /> ---_ ---- � ------ Total Length __��---------------•-: <br /> LEACHING LINE [r�No. of Lines _ .c i! <br /> - ., 14 t <br /> D' Box ___I.�'' Type Filter Material __SrI Depth Filter Material _-- - ---------•---���j <br /> -U -- ------ fU Property Line. ---- ------------------- <br /> Distance to nearest: Well ___ -- Foundation -----.--------- p rtY <br /> Depth Diameter --- Number -------------- -- <br /> ____-- Rock Filled Yes ❑ No. <br /> SEEPAGE PIT <br /> WaterTable Depth -------I-----------------------------= -------Rock Size --------'------------------------ <br /> Distance to nearest: Well ______________________________ <br /> Foundation'=* "Prop. Line ------------- -------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------­-------------- <br /> Septic Tank (Specify Requirements) is -- 1�t 7wy ------� .----------- - <br /> Disposal FieldSpecify Requir'men`s � , <br /> 1 a � �.a ---------------- ---------- --------------------- <br /> - t----=----------------- <br /> ------------------------------------------------------------- <br /> ------------------------- <br /> -------------------- <br /> ---------------------- ------ <br /> (Draw <br /> - <br /> (Draw existing and required addition on�reverse side) <br /> l 1 hereby certify that 1 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 /> k "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California.'' <br /> ` Signed -- - - - ------- ----------- <br /> - Owner <br /> B ----- Athanownedi - ------------- Title - ---------------------------------------------------------------------- <br /> Y ------- ---- <br /> (If other <br /> FOR DEPARTMENT USE ONLY g <br /> i APPLICATION ACCEPTED BY -_G 1tAa-� - ---------------- <br /> DATE z��. l <br /> BUILDING PERMIT ISSUED --------•_ ---- -- - ------------- <br /> • ------------------- ---------- DAYE <br /> ADDITIONAL COMMENTS ---- --G------- ` xa.-- <br /> --------_`-�—�---- --------------------------------- ------------------- <br /> ----------------------- <br /> --- ------------ ---•------- <br /> i:4_(el <br /> ( Final Inspection b ----------------------------Date --------------- ------ <br /> 1 SAN.JOAQU.IN LOCAL HEALTH DISTRICT <br /> i <br /> E. H. 9 1-'68 Rev. 5M <br />