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FOR GI=FICE JSE: APPLICATION-FOR SANITATION PERMIT <br /> � r <br /> Permit No. <br /> ----- ----------------------------•------ ------------- <br /> (Complete in Triplicate) ' - <br /> ------ ----------------------------- „ <br /> Date Issued <br /> .M1 Z-;, ". 6_-:�7_47 <br /> This Permit Expires 1 Year From Date Issued <br /> ---------- <br /> Application is hereby made to the San .Joaquin Local Health District for a permit to construct and install the iwork herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------/3/�----1(0------ Al Lll--------------M-V ------------CENSUS TRACT --- <br /> --------- <br /> 92-3 <br /> ------ <br /> �2 -Phone � <br /> Owner's Name ------- -Vjtq L <br /> ; <br /> Address -------13-1 <br /> city _ .f1N`rl - ------------------- ------------------- <br /> 5------ --mQ-`------�A1- -- �-- ' <br /> Contractor's Name - - N--E--{ -�- — �� -�"""---- -----''--- -------------- <br /> ------.License # ------------------------- Phone ---------' ----------- <br /> Installation will serve: Residence 2-,Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel E],-Other ,�� ------------------ : <br /> Number of living units.----1---_-- Number of bedrooms __'�,l__ _Garbage Grinder _ _«�_-_ Lot Size ___ --X_-_,� -__-.-- -- 4 <br /> Pri to . <br /> Water Supply: Public System and name ._________________ __ ---- -------- 11 <br /> E <br /> Character of soil to a depth of 3 feet Sand' Silt❑ Clay ❑ Peat El Sandy Loam ❑ _ Clay Loam. �! <br /> Hardpan ❑ Adobe )] Fill Material _ 0--- If yes,type.+y.-i ------------------j �] <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, <br /> etc. �s '6e�placed on reverse side.) t <br /> F seepage pit permitted if public sewer is �ail"able within 200 feet,) <br /> NEW INSTALLATION: INo septic tank or <br /> I <br /> PACKAGE TREATMENT R [ ] SEPTIC TANK[ j A--Size-_—-_-----__------- __ Liquid Depth ----- -------------------- <br /> I T -R <br /> Capacity ----- '--------- Materiala ------------------- No. Compartments ----------- <br /> 1 <br /> 1, i <br /> t } Distance to nearest: Well ___-- _1____i - - -Foundation _ Prop. Line .----•--------------- <br /> �. r. <br /> LEACHING LINE [ ] , of Lines`_ -4------ ------ Length 6 each line-----------.---- -=--------- Totai Length ------- -------- <br /> ------------- <br /> \� <br /> i.k a JCC# ; <br /> No. <br /> "'� I. h Filter Material p` >$ox �3 t TYPe Filter Material ---- Dept a ie l - <br /> Distance~to nea+est: Well ____- ,foundation- ____---------».- _.l -- Property Line _- ._____. <br /> I <br /> I I <br /> , <br /> SEEPAGE PIT ] DeIpth __ _____ __ _______ Diameter ---------------- Nurhber ---------------- <br /> -------- --- Rock Filled Yes.❑ No .❑ <br /> fWater Table Depth --------------------------------------- --------Rock Size -------------------------------- <br /> F ; <br /> Distance to nearest: Well --------------------- - <br /> ------- ----------Foundation--- -------- ---- Prop. Line '..--------_----•-- -- <br /> _- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ______.__----------_--------------1 <br /> i ;: I l ------ ------------- <br /> Septic Tank (Specify Requirements) Al----- ------------------------------------------------------------------- ------ --------------------- „f <br /> Disposal Field (Specify 'Reg6ireme6ts) ------ � ._ <br /> iii ) , , U 4fa i <br /> T .. 1 , <br /> - -.._ <br /> - r <br /> I t I (Draw existing and required addition on reverse side) <br /> 1 <br /> 1 hereby certify that I hov prepared raw <br /> application and that the work will be done in accordance with[San Joaqu n <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- + <br /> sed agents signature certifi4s 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 /> t <br /> as to become subie o;Wo 's Colinpensation laws of California." <br /> Signed --------- - --------------------------------------------- Owner <br /> } s <br /> By ______ Title <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> I APPLICATION ACCEPTED BY ______1.-[_I\\--�n--------------- DATE _.____ -=----� -- � r <br /> - - <br /> - - <br /> BUILDING-PERMIT ISSUED.—_ <br /> ADDITIONAL COMMENTS --------- -- -- ---- ---------- ---- ----------------------------------- <br /> -- -- ------------------ <br /> ------------------- <br /> -------- --------------------------------- ------------- <br /> i----- - -- ----------- ----- ---- - ----------: --- --------------------------------------------------------------- il----•------------•---- <br /> ------------------- ------------ ---- <br />! Final Inspectio -------------- -----------Date ------ --- - -------�]----- - ------------ <br /> SAN 1OAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />