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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ---- ----- Permit No: .-75� <br /> ------------------------- --- <br /> (Complete in Triplicate) <br /> --------------- ---- ----------------------------------- <br /> _._____________________________________ ---------- This Permit Expires i Year From Date Issued <br /> Date Issued --���7�'_ <br /> i <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 wit}i County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ------.�/>----------------------CENSUS TRACT --f-----------_------Al <br /> Owner's Name cS _ -Phone `/�_�_?_ �� s7 <br /> Address / --------------------------------------------- --•------------------• CitYf� f1� <br /> Contractor's Name --/SFS / � IYIC--- C7�_.-----------License#177-fg --- Phone-� ��_-- <br /> Installation will serve. Residence W Apartment House F] Commercial :❑Trailer Court ❑ � <br /> . 1-:� - , I <br /> Motel ❑Other ---------•---------------------- <br /> Number of living unitfs:____/__'_-,Number of bedrooms .__-----Garbage Grinder ,C P.___ Lot'Size -_37 _-/, .11C -----.______________ <br /> Water Supply: Public System and name . ------------------------------Private <br /> r a �•_ f � <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat_E""Sandy Loam ❑ Clay Loam.7] <br /> frf Hardpan ❑ Adobe--R—Fill-Material ------------ If yes, type __________________________ <br /> (Plot plan,,showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.} <br /> NEW INSTALLATION: l <br /> (No septic or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK:[ ] Size----------------------------------------------- Liquid Depth _._______________-----.. <br /> 4 _ , <br /> Capacity ------ ------------- Type ---------- Material------------- -------- No. Compartments ------•--- - -_--•- <br /> Distance to nearest: WelI ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING L NE <br /> [r) ., '' No. of Lines ------------------------ Length of each line--------------------- ------ Total Length ---------------------------- � <br /> D' Box ___.___ ---- Type Filter Material ____________________Depth Filter Material <br /> --------------------a--------------- ------- <br /> t 0, Distance to riearest: Well--.__------------------- Foundation-_--_ ,_ ___________ Property Line. _____•------------------ <br /> SEEPAGE PIT [ ] ' Depth _.___.__?_______._ Diameter ________________ Number ------ --------------------- Rock Filled Yes ❑ No .❑ rn <br /> r <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> { --------------------------------------- Foundation ----------- ------ Prop. Line _..______._._:..... <br /> i o nearest- Well ---------------------------- --- <br /> REPAIR/ADDITION(Prev.Prev.DS'anitatio t } <br /> / n Permit# --------�------------------ ----------------- Date ---------------------------------- <br /> Septic Tank (Speci�Fy 'Requirements) ---- --- ---------- -- � --------------------------------------- ----------------------.._--------------------------------� <br /> Disposal Field (Specify Requirements) -----------67C?_______--o-4-_,Z,� _________ s" <br /> --------------------------------------------------------------- -- - <br /> -------------------------------------------------- <br /> -- --=-------------------------------------------------------------------------------------------- <br /> - ----------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies 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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------------ -------- ---- -- ---- ---- -----------------------. Owner <br /> ----- <br /> BY ----- - -------------------------- ----------------------- Title ---- --- -�'J --- <br /> (If other-t- <br /> an owner) <br /> F .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY __-_ __1_ 11 _________________________ DATE -- -- - -- -- _-.7_.lr�''.__-------- <br /> BUILDING PERMIT ISSUED �----- - ------------------ -------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS -- -- - - --------------- ---------------------------------------------------------------------------------------------------------=--------------------------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> t <br /> ---------------------------------------------- ------------------------------=--------- <br /> ------------------ -- ------------------------ _-------------------- ----- <br /> _ . -------------------- <br /> ------------------------------------------- <br /> P Y �y <br /> - - <br /> Final Inspection b _____.Date ___. __ __f <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M, <br />