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FOR OFFICE USE: , <br /> APPLICATION FOR SANITATION PERMIT �� <br /> ----------------------------------------- <br /> ----------- <br /> (Complete in Triplicate) Permit Na. --7-,/._'__ _______. <br /> ------- -=----------------------------------------------- <br /> This Permit Expires 1 Year From Date Issued Date Issued --------- ---- <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> JOB ADDRESS/LOCATION ._-- - ------. ------- `--�.-F�_S__`�� e-------------------CENSUS TRACCpT -------------••--•--_----- <br /> Owner's Name -------- 1'--'--------- f 5--------------------------------------------------------------- yPhone ----'7� ��-_ ,7 3 <br /> Address � 4115--Z <br /> 4177'701,� �� I j City ----'-�-- �_-CLQ-_?-)_p_ OY� <br /> 1C1t, fla� et�±-_fQ _�__[--Q�icense # Phone <br /> Contractor's Name ____ __________ _ <br /> Installation will serve: Residence [Apartment House-E] Commercial ❑Trailer Court ;❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:----/____ Number of bedrooms ----�--Garbage Grinder _ Q-____ Lot Size -� a---__�!-_ -r__:._____ <br /> Water Supply: Public System and name -------� 119L-----__--------- ---------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam 'E] <br /> Hardpan ❑ Adobe eFill 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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT { ] SEPTIC TANK, ] Size------------------------------------------------ Liquid Depth _-___--_.______-______-. � <br /> Capacity ------------- ------ Type -------------------- Material---------------------- No. Compartments ------•--------------- <br /> istance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> �, s <br /> LEACHING LINE No. of Lines _______ ___ e <br /> _____________ Length of each lin _._--��-_.___._.____ Total Length ____---�{ .______-___-- <br /> 'D' Box __/------- Type Filter Material 4&ck Depth Filter Material __________ ___ _____---------------------- <br /> Distance <br /> __________-----___._Distance to nearest: Well ----h4i'lle------- Foundation __fj_---------------- Property Line -----29 <br /> SEEPAGE PIT Depth -- .--.f~....... Diameters`_____ Number --------/----------------- Rock Filled Yes @2-' No ❑ <br /> �s <br /> Water Table Depth ----- �$--------------------------------.--Rock <br /> i------------------------- -----Rock Size --- --------------------- <br /> Distance to nearest: Well __________________-----Foundation ---/0_----------- Prop. Line ___ .__.___---. <br /> REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ----------------------------------- s---------------------------------- ---------------------------• --------*------------------ <br /> Disposal Field (Specify Requirements) ------------- -----.A -------------N--------------- <br /> ------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------•------------------------ <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 become subject to W kman's Cpensation laws of California." <br /> Signed ' --------------------- --------------------- 0-&D-el— <br /> By <br /> 'N eBY ---------- ------------------- -------- ---------- --- ----- ----------------------------- Title ------- - --------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _-_ __ DATE _..1 "'___ _- '-___ ---.---- <br /> BUILDING PERMIT ISSUED ------------------------------------ ------------------- ----------------------------- DATE .. ----------------------------------- <br /> ADDITIONALCOMMENTS ------------------ ---------------F-------------------- -------c----------------------------------------------------------- ------=--------------------------- <br /> ---------------------------------------------------- -- ---- ---- ' f ;-�'------ 7-/------------------------------ ----------------------------------------- <br /> ----------------------------------------------------------------------------------------- <br /> -------------------------------------- --- - --------- - - -------------- -------------------------------- -----------------DateFinal Inspection by: _Date <br /> SAN JOACQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />