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FOR OFFICE USE: " ~ <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ----------------------------------------- <br /> - . <br /> (Complete in Triplicate) <br /> -------------------------------------------------------- q <br /> : ..,, Date Issued -----`�-_---- <br /> This Permit Expires JrYear FromMate Issued <br /> ----- <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 /> JOB ADDRESS/LOCATION . / -7/�0 :-S--------( / /Q�_?"w------AJ C i -- ---CENSUS TRACT ---- -- --�Z ---- -•-- <br /> IOwner's Name ------AN_�_�-E�.!�1.------- 1�'1�-" 5Z 1r --------- Phone 5 7�. <br /> I '�-P------- --------------------- <br /> Address __-- ---- `- u <br /> ---107_�_Q---+5------ �---�,.1 lilt-01��---- ------ -�v ----------�--- ciry -=-------. =--- <br /> -" e <br /> Contractor's Name ---------t. W 4�.'= �----------------------------------------- ------------- License # ---------:---------- <br /> Phon <br /> Installation will serve: Residence partment House-F-1 Commercial :❑Trailer Court l❑ ` <br /> Motel ❑ Other ---CT�1Ra1_ -WgS!'fINE-, lvl�rNtc ��a - ` <br /> Number of living units:_-_____l�_._ Number of bedrooms ____________Garbage Grinder __f �__: Lot Size _______ _ ,ti-moi <br /> .! -=__ <br /> Water Supply: Public System and name _______________ _\_:"---____ _ Private <br /> -------------------- ---------------------------------- <br /> j' Character of soil to a depth of 3 feet: Sand !Silt❑ • Clay ❑ Peat❑ _.Sandy Loam -El <br /> Clay Loam.1E] <br /> FJardpan•❑1�-A oe�❑' FilkMatecial-_�!'=If yes,--type-­--------------- - <br /> � <br /> (Plot plan, showing size of lot, location -of system. in relation to wells, buildings, .etc. must be placed on reverse side.) 4 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ SEPTIC TANK-f I- ;'�`^'Size----------------------------�---- Liquid Depth --------------------,- <br /> t � T 1 Material_____________________ No. Compartments f <br /> ---------- ----- Type ------------ - ----------------------- <br /> CapacityQ <br />( Distance to nearest: Well - ---------Foundation '--------------------- Prop. Line-------------=--------- <br /> LEACHING LINE [. No. of Lines '--------------------- Length of-edch-�line!,j.,�---------- -------- Total Length< 'i--------------- <br /> I / _ <br /> 1 {{ ilterj Material ------------- ----f <br /> Bo. ----------D' Type Filter Material Depth F { <br /> ne ---------=- <br /> ----- ----- <br /> Distance to nearest: Well -------- --------- Foundation f Property yLi <br /> t -- j Rock Filled Yes ❑ No I❑ <br /> SEEPAGE PIT [ ] Depth ' ¢---------------- Diamet er=--T=--- Number -------- <br /> Rock Size ---- ------------ <br /> ------------------------ -- �- <br /> i Water Tables,Depth.. ,_< - t <br /> -Foundation -------------------- Prop. .Linet-•-------------- <br /> Distance to nearest:-Well -------____------------------------ - - " <br /> . c• T, <br /> • 7 "... <br /> REPAIR/ADDITION(Prev. Sanitation Permit'# ------_..--------------------•------- Date ____-______•--------------•- 1 <br /> t. �''� � ---------------- <br /> Septic -- <br /> Tank (Specify Requirements) -----------a} -- ------ ` - - -- --------- <br /> I <br /> -- FM1 <br /> .Disposal Field {Specify Require ments) __x`_10------919 ...... &�� ��� ��0------�-----�� t� 't r'l�'J'"`---_- <br /> II T- u c ——t - �" t --- ------- �}------._ e -*_t-�r_r,-rJ�. -�--�-------- <br /> 1' A14<r s r1 _ '11 �, t!-- ,at -1 � - F Feil <br /> -- .� :r-. .�.Y= • Draw-existin and re wired a�3dition-on reverse side)­,am----XF <br /> f J" qr <br /> ` n and that the work will be done in accordance with San Joaquin <br /> 1 hereby certify that I have prepared this applicatio <br /> County Ordinances, State Laws, and.`.Rules and Regulations of the San Joaquin Local Health District. Homeowneror licen- <br /> ` sed agents signature certifies the following: i <br /> "I certify that in the performance of the work'for which this per�it is issued, I shot] not employ any person in such manner <br /> as to become subject.ta Workman's Compensation laws of California." <br /> Signed -- - - --------- = , • ----------1 --------------------- Owner <br /> r. <br /> BY - - -, :- -- - - -- - - -------------� -------------'-? Title ----------- -------------- - ------------ --------------------------- <br /> If other than owner}' # <br /> FOR DEPARTMENT USE ONLY, r' <br /> APPLICATION ACCEPTED BY _____ t_.s-- ��i ----- f i ---------- DATE <br /> -- -------------------- ------ -____-__-DATE __-------- --------------------------- <br /> BUILDING-•-PERMIT ISSUED.:---- - -- ------ �- <br /> I `ADDITIONAL COMMENTS --------- - ---- ------------------------------------------------ <br /> --- - -------------- <br /> -- ---- ----------------- - _ <br /> ---- --- _ -q <br /> -------------- --------------------- = Date __f _-�/_- <br /> Final Inspe ------------------ <br /> ' :SAN JOAQUIN LOCAL. HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. SM <br />