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FOR OFFICE USE: T <br /> APPLICATION POR SANITATION PERMIT / <br /> ._...." _:.__..._.. Permit ._ ... <br /> i _ _(Cortrple a in riplicate) <br /> P mit No. <br /> =< <br /> ............... <br /> �� <br /> . ._ Date Issued /.�`� <br /> ' ......._ ..._....---•••• •. -• <br /> This Permit Expires 1 Year,from Date Issued / <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> descr ed. T is ppli ion is mad in compliance with Count. Ordinance No. 549 and existing Rules and Regulations: <br /> / Lz � �°. <br /> k JOB ADDRESS/LOCAT O - . .... 35-- <br /> Phone <br /> 3 <br /> Owners Name ----- ---. g.... ............... . . <br /> ..._'-,',,CENSUS <br /> � y <br /> �y - <br /> ........... <br /> ... <br /> Address % =— • ._ _...-•-- -•--�� ......... --•--....City ........ ---•---- <br /> W - <br /> " <br /> XF <br /> Phone -x <br /> ...........----•-Contractor's Name' .............. ................................................... <br /> Installation will serve: Residence 0 Apartment House f] Commercial oTraller Court C1 <br /> Motel 0 Other <br /> Number of=living units:-.._ ... Number of-bedrooms .,�.....GZ:.- <br /> arbage Grinder -. Size ...- ---G �•••--.•;• ._. <br /> a Water Supply: Public System and name --.....I.----- -Private <br /> ................ ..... ....•------••---- <br /> ..........i...i.....1....4........x..... " <br /> Private 0� <br /> Character of soil to a depth of 3,feet: rSid Si1Q ay Peat Sii foam-�-___ cry!. - im00 <br /> � 1 <br /> i # <br /> H� n❑ 1Globe 0 .'Fill Mciterici�.. ......If 0t)type............... <br /> * � . <br /> (Plot plan, .showing size of lot, ration aT 4yst�m in relation #o wells, buildings, etc. must be placed on reverse side.) <br /> f <br /> NEW INSTALLATION-. (No ,sept ctank or seep ge!pIt permitted if public sewer is available within 200 feet,) ;.., <br /> PACKAGE TREATMENT 1 I SE=PTIC TANK'ir ] size.......L2..`0........ ................. Liquid Depth _1.2i <br /> ,_ .. <br /> Capacity _-_�1 Z.qct..__"Ty ' Materia! L.--: 'tNo. Compartments .._ _ <br /> h I 5 � k <br /> Distarice.to nearest;�YV�II= `.•- _ ... _.Foundation ...................... Prop. Eine ---..�d.. <br /> :. ... <br /> k <br /> } 'LEACHINGrTiNE [ No. of lines -----__3 . °� tlt�afi each`line...__.7. ............. Total Length. ---... .���.....-- <br /> _. tom . `� y —_ i <br /> 'D' Box ----...._... Type Filter;Mgteildl Cr`.. ----..Depth'filter Material .- '' ............................. <br /> pistance,to <br /> nearest: Well .. Foundation t <br /> rt -------•--• i" Property Line ..._. ' - <br /> SEEPAGE P1T_ [ Depth t.......:.......... Diameter -- -Number .... ```....--....__.. ..... Rock Filled Yes ❑ No 0 <br /> Water Table Depth ............................... ......... _ .Rock Size --•---•----••-•............... <br /> Distance to nearest: Well ':2� 1-Foundation .--•................. .Prop. Line ....... <br /> -------------- <br /> REPAIR/ADDITION jPrev. Sanitation Permit# --•--:_ ......... ) <br /> E -.-----..... <br /> E. Septic Tank,(Specify Requirements)...........:.............................. ............k.......... . ............ .............................-f ----••-• <br /> Disposal Field (Specify Requirements) s ................. <br /> ............... .....••------------ ......... <br /> —. <br /> (Draw existing onoequired addition on reverse side) <br /> 1 hereby certify that 1 have:prepared this applicaflo qnd-that the work will-.be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joa-qWi Local.Health:District. Home owner or licen_ <br /> sed agents signature certifies the following: <br /> l; "I certify that in the performance of the work for whichthi ermit is Issued, I shall not employ any person In such manner <br /> as to become subjec to Work rn 's pens an law California." <br /> Signed <br /> = Owner <br /> BY --------------- title _.. <br /> t (if other than owner) - <br /> ' <br /> F9R DEPARTMENT USE ONLY, . <br /> APPLICATION ACCEPTED BYi..li - ------ _.__. -._..... . _-----.,-..... -----------------,DATE.,=....:.:-���� �. .._.::...._ _ <br /> fBUILDING PERMIT ISSUED ---------=------- ------------------------------------ ------- --.1 ----------------......................... <br /> ADDITIONALCOMMENTS -------_•-----•-------•---•--------------•---------••---..................................................... .......................:........................... <br /> I ----------------------------------•----_-----•--.. '--••--•-•----.--•- ----•.•-.._.....-....._........._------_.._._ •--------•---------..-------- -- <br /> f-r� � <br /> Final inspection by: .----------•--- - ..... ------- <br /> --------•--••'--•------------------------------------Date )' ......... ._ <br /> iH 13 24 1-68 13ev..5M , SAN JOAQUIN OCAL HEALTH DISTRICT 8/74 3M <br />