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_ FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------- ---------------------.-------j <br /> Permit No. <br /> �.�. . . I a �i- <br /> - n.Triplicatel- <br />......... .............................. This Permit Expires 1 Year From Onto Issued Date issued _� y_. <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. 519 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATION 0 O :!_.... _._ ......... ......CENSUS TRACT <br /> Owner's Name .. w1. ......................••...........................Phone -----------------.._.............--- <br /> Of <br /> Address ;---- '47yZ........7..... -----•- • ......................:City .��..:.:..... - <br /> Contractor's Name .. ..License # .......... Phone - <br /> installation will serve: Residence*Apartment House❑ Commercial❑Traller Court 0 <br /> Motel ❑Other................:. --------...... <br /> �_._'�°'�..............i... <br /> Number of living units ---- Number of bedrooms ........Garbage Grinder _.:... ..... Lot Size �... ..._ ... 0 - <br /> Water Supply: Public System and nam -----• .................................................. <br /> ..........................._-• --..............._.--•---................_..........._................Prlvate�. Q <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom❑ Clay Loam[ <br /> Hardpan ❑ Adobe 0 Fill Moterlol ............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: (No septic`tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANKt} 4.................... Liquid Depth ....... � <br /> Capacity �rti_Q 0.._---- Type��'M,..r p.w..`.... Material-- ...... No. Compartments ................. <br /> Distance to ne est: Well/$rel.____••.....................Foundation ..!..Q..:-........._ Prop. LM847r............... � <br /> LEACHING LINE �} No. of Lines ._ __..._..�"_ <br /> Length of each line... _`............... Total Length .'..>.�o... <br /> 'D' Box ± . Type Filter Material ,4:.1'f..........Depth .Filter Material ._.�.9. '..........................._ <br /> Distance to nearest: Well/(7�.'............... Foundation _ 1,0.............._. Property Line -- - ••:;•--.......---• <br /> SEEPAGE PIT Depth ------------- <br /> i---- <br /> �-j.---_ Diameter ' ' ._.. _ <br /> 1` ;;.::. Number Rock Filled Ye No <br /> .�F UVrTi Table depth . d�............................. :..#tat!S ze _ ,. <br /> Distance to nearest: Wei I--lZ ..................Foundations -•----•. Prop. L '".............. <br /> REPAIR/ADDITION[Prev. Sanitation Permit;# ---.----.-............ ............:-------- Date ....................:__ <br /> Septic Tank (Specify Requirements) - : <br /> ...................:........................................................•............................... <br /> Disposal Field (Specify Requirements) ........................................................... ....__...,....................---- ---_ <br /> ---------- -------------------•..-_....---------------..........._......................-.......................................................................................... <br /> :......----•............ ...... •----- - ---------------:--------- ........................_..................•................................................................ ....... <br /> "(Draw existing and required addition on reverse side) <br /> I :hereby certify that I have prepared this applitalion and that the work will be done in accordance with Sian Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Heal&District. Home owner or liven, <br /> sed agents signature certifies the fallowing: <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 be the subject o W r an's Cor pensation laws of California." <br /> Signed- .. .:. �..-. . -------- ---=------------- •----- Owner <br /> ----...._. Title ------------ - ----- --------------------------- ----------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION. ACCEPTED BY ..--------•--•.........--- DATE " .~7. _ <br /> BUILDING PERMIT ISSUED -------- -------------------------------- - DATE _...-----.-.----.-._............-------- <br /> ADDITIONAL <br /> --_ -.ADDITIONAL COMMENTS .-. _ -- .X.__- -_ - --- <br /> v / <br /> f%�! - !?_` .... . <br /> ........................ ........ • .. .-. <br /> ............................... ................. ___--._...-----_-_-......._._.,......-_-__.--...- .................................................................... <br /> Final Inspection b n <br /> .....................................................Date --- -_--_--_----- <br /> EH 13 24 1--68 Rev. 5M f i SAN JOAQUIN LOCAL'HEALTH DISTRICT 8/74 3M <br />