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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ---- - ------- - -------------------------------------- <br /> , <br /> --------------- ---- - (Complete in Triplicate) <br /> ---------- ° ti �� .fir Date Issued .' =- ' - <br /> - <br /> 1 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 /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> al ,F _pu?.-- ------------/'lu -I�Go--------- --- <br /> CENSUS TRACT _-_- --.--------- <br /> J08 ADDRESS/LOCATION_._-�--------- --- -- . - <br /> Owner's Name ------ -k161 - uv�-r---------------------------- <br /> --------------- ----------------------------- -------Phone -- --------------------------------- <br /> 'I SIC <br /> Address --- '�- --- -- - -- <br /> ------ city //-Q Ira- -1 ------------------------------- <br /> Contractor s Name _---------------- ---------- <br /> Installation <br /> - - ------- -------- - <br /> --.License # -- -- --- Phone -- <br /> -------- ----------- - <br /> Installation will serve: Resi�kence [Apartment House Commercial ❑Trailer Court <br />' (Motel ❑Other -------------------------- <br /> I <br /> ------------ ---------- <br /> Number of living units:- ------ Number of bedrooms -�____-Garbage Grinder _--_ - <br /> --- Lot Size--2._,�=�,'_`'�-�--- ---------- <br /> ------- <br /> �a�•k"...*� %'A ( Prate <br /> Water Supply: Public System and naAe --------------------------------------4- ------------------------- - --- I 1v I <br /> Character of soil to a depth of 3 feet: Sand'L� Silt❑ Cl py �: Pe C1Sa dy Loam El Clay ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material If s,typerz, ; tr, <br /> I 1 IN <br /> .: �. <br /> (Plot plan, showing size of lot, locai�ion of system in relation to' yells, buildings, etc. mustLbe-placedwon everse side.) <br /> i septic seepage pit permitted if public�sewe is available within 200 feet,) <br /> P NEW INSTALLATION: (No se tic to k or <br />] PACKAGE TREATMENT ( I SEPTIC IiANK'[ ] Size------------------- -------- Liquid Depth ------------------- Q <br /> No. Compartments <br /> ---------------- \ <br /> ,. Capacity Type ------------------- Material-------------.------- p <br /> } Distance to nearest: Well -------------- - Foundation ---------------------- Prop. Line -------------------•-- ` <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.- -._'------------ -- Total Length ---------- <br /> - ------ <br /> 4 De th Filter Material <br /> ,'D_' 8ox,-_--,----- T .. e,Fllter Material -------------------- p - . .....�.�.-._ �_-�... --�.. <br /> Distance to nearest: Well -w'+ v z---- -- FoundationC-,k_------------- Property Line -- <br /> SEEPAGE PIT [ ] Depth - Diameter <br /> --------- -------- <br /> ------------ -- Number -- ---------------- <br /> - <br /> -----. Rock Filled Yes F1 No i❑ <br /> Water Table Depth ---------------------------------------------Rock Size t -------------------------------- <br /> Distance o ne- <br /> • Foundation -------------------- Prop. Line -------- ------ <br /> arest: Well _--_-----._---_ <br /> f ! : s <br /> ! ----------------------------------- <br /> : <br /> ------- ------- --------- Date ------------------•--------------} <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# -------- ------ <br /> Septic Tank (Specify Requirements) Y - - - ------- <br /> ­ <br /> - <br /> _. -Disposal Field (Specify Requirements) --------------------------------------------- ------------------------------------------------- <br /> It <br /> ------------------------ <br /> 1c-------- }"' - `rr �= <br /> -- <br /> A <br /> ---- <br /> ' in S 4 r A -6'� OJ f� --��--- ---� ------ --- ----- -- - ----- -----'-- --------- -r ._-_ <br /> (Draw existing and required addition on reverse side <br /> 1 hereby certify that I have prepared this application and that th _W&k will-Lie done in accordance with San Joaquin <br /> County Ordinances, State Lawstiyan Rules and Regulations,of the San Joaqui>Ii Local HeaHhDistrict H me owner or licen- <br /> sed agents signature certifies the foh wing: r <br /> "I certify that in the performance of the work 4for�whikhNh"is'permit,=is"issued, I shall not employ any person in such manner <br /> -. „ <br /> as to becom s bject to W rkma Compen tion-claws of,iCalifbrnFa. t-• .�.,,A -, 34 <br /> �q I <br /> Owner <br /> Signed <br /> ] -- Title ---- ----- - - --- -------- � <br /> ---- <br /> By ---------------- - -�--- -- <br /> (If other than owner) �� ` <br /> 1 <br /> FO EpARTN1ENT USE ONLY <br /> � A,PRL-IC-ATION- B.-ACCEPTED-.•BY—�,�..-.�. �..!_ -- �-`--:.,.�-�_---= �--_-= _=--�,-,...-��..:_--�_-�__DATE.__-__�----_--��------- ------ ------- <br /> DATE <br /> BUILDING PERMIT ISSUED -- --- ------------- ----- <br /> f ADDITIONAL COMMENTS ------ ----- -------------------------------- ---------------- <br /> I -- E __________3_ ------------- <br /> ----------- <br /> - - ____ <br /> .------- <br /> ------ <br /> ------------------------ <br /> --------------------------- <br /> yr -------- <br /> - - - --------- , ------------------� --- <br /> ___ 7-' - ____.-__-..._-- <br /> _-- _ __.___----------------- --------- ------------------------------------------------ ---------- <br /> _. <br /> __ --------------------------------- <br /> . I <br /> -------- <br /> - <br /> ------- <br /> --- - -- --- _ ________ _____ Date ._ ----� --CJ- -_----- <br /> - - -.. <br /> Final rniby: ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> t- F. H. 9 1-'68 Rev. 5M <br />