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FOR OFFICE USE: p. APPLICATION FOR SANITATION PERMIT Permit Na. <br /> [Complete in Triplicate) <br /> --�!-r- 7-� <br /> ------------- <br /> - Date issued _ -'- -------- -• <br /> f' { This Permit Expires 1 Year From Date issued <br /> ---- ---------------- --------------------- <br /> _ '� ermit to construct and install the work herein <br /> Application is hereby.made to the San Joaquin Local Health Distract far a p <br /> d. This plication is made`.in compliance with County Ordinance No'. 5A9 and existing Rules and Regulations: <br /> describe p <br /> ------ <br /> 0� -- �.L�'�`�-1.....CEN5U5 TRACT -- ------ <br /> JOB ADDRESSAOCATION ----- -- --------------------- one ----------------------------- <br /> ---------- ------ P ------- <br /> owner's Name _.�_�- �, ,�� <br /> eoc//5 City ------- �.----- ---- <br /> Address ---------- <br /> / �5 :_ .. 'L------------------- -- �3q -_ Phone <br /> License # <br /> Contractor's Name _- _-___: Residence �artment House,[] Commercial ❑Trailer Court <br /> Installation will serve: <br /> _ - <br /> Motel ❑ Other ------------------------------------------- � <br /> Garbage Grinder-- -------------------------------------------- <br /> -----Lot Size -- ------------- <br /> Number of laving units:._-------- Number of bedrooms ___----"---- private <br /> ------•- <br /> Water Supply: Public System and name ----------------------------------------- Peat❑ Sandy Loa <br /> Character <br /> ❑ Clay LoomE] <br /> p V _... - <br /> Charac#er of soil to a de th of 3'feet: 'Sand' Si1fi❑ Clay <br /> ._. ... w .... Adobe❑ e =_ <br />. _ Hardpan ❑ Fill Maternal .��----- if yes,type <br /> (Plot plan, showing size <br /> of lot, location of system in relation soywells, buildings, etc. must be placed on reverse side.1 <br /> t„ <br />_ it ermined if public sewer is vailable within 200 feet,) �] <br /> NEW INSTALLATION: <br /> (No septi i tank or seepage p p Liquid Depth -_--- <br /> ------- <br /> Size --`�------- -- --------------- <br /> SEPTIC TANK b 2 ____... <br /> PACKAGE TREATMENT ( ]_ __. . <br /> F f DQ_ -_ T e Material `f '� No. Compartments ---:--• <br /> Capacity::- ---- Ty <br /> _ A. <br /> S V Foundation --l- a------------ Prop. Line ----�-------------- n <br /> Q ( Tota! length �1r <br /> -------- ------- <br /> I a Distance to nearest: Wel! ------------ ------ /D -----•-------- <br /> t No. of Lines -------1--------------- Length of each line- / ----------- <br /> LEACHING LINE [ } <br /> - `1 � _ Type Filter Mat�aal�fPC�-•----Depth Fitter Material ---� --- --- - <br /> D' Box --- -- Yp Property <br /> S� Line. ----j-••--------•---- <br /> -------- Foundation -------------- ---- - <br /> L------•-"'Dis'tance�to'nearest: Well ---��----- - ---- ---- Rock filf� Yes ❑ NO <br /> I Depth`" Diameter <br /> ---------------- Number ---------------- <br /> SEEPAGE PIT L 1 I <br /> }' � � ' -----------'------Rock Size ---- ----- ---------- --- -•---- <br /> Watef Table Depth ----------- <br /> ---- <br /> .rl ----------- ----- Foundatiara <br /> ------ Prop. Line .----------•---------- <br /> Distance to nearest:Weil,---------- ) <br /> l • �je% F Date ------- -------------------------- <br /> i6n(Prev. Sanitbtion Permit# >.,.-?-J : , <br /> {I y 4 <br /> eeif Requ r"ementsl - {f'--------------------------------- J <br /> Septic Tank (Sp y �d --5 1 �- -� -- <br /> L4— c -c d- ---------------- <br /> Disposal Field (Specify 4Req rrementsl __________•--------------------- <br /> 1 <br /> ---- ---------------- <br /> --------------------- ---------------- - <br /> ------ ----------- ---------F_ _----------------------------- <br /> _-_ __-______-___-_--_____-____-_________-_____-__.__.____-_____________----------------------------------- <br /> ----------------------------r-- (Draw existing and required addition on reverse side) 'F <br /> b certify that I have pr pared this appl'scation and that the work will be dens in accordance with San Joaquin <br /> I hereby f]► <br /> Skate Laws, and Rules and Regulations of the. S°" Joaquin Local Health District. home owner or licen- <br /> County Ordinances, , <br /> sed agents signature certifies the following: permit is issued, 1 shall not emp{oy any parson in such manner <br /> "I certify that in the performance of the work for which this p <br /> as to become sub'ect to Workman's Compensation laws of California.'!' <br /> s Owner <br /> �� <br /> signed'J. _ t f <br /> -- ----- Title - ------------------- <br /> BY other tha owner) <br /> FOR DEPARTMENT ' ONLY <br /> E <br /> USE <br /> ------------------------------------------------------------------ DATE _.. hl <br /> APPLICATION ACCEPTED BY t- r -----------DATE ----------- ----------------------------- <br /> --------------------------------------------------- --------- ------- ------------------------------ <br /> BUILDING PERMIT ISSUED ----'- ----- ---------------------- <br /> ADDITIONAL COMMENTS ----- -------------------------------------------- ---------------------------- <br /> -------------------- -- <br /> ---- -- -------------------------- - ----- <br /> ---- ----- -- <br /> -------- ------------------- -- <br /> --,� ------ <br /> Date - -------- <br /> Final Inspec' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t <br /> E. H. 9 1-'68 Rev. 5M <br />