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_ FOR OFFICE USE: IV�o' R APPI,I�AT10N FOR SANITATION PERMIT ' (� j� . <br /> Permit No. 1-- <br /> 1- f - (Complete in Triplicate) <br /> Issued ---- ------------- <br /> . <br /> -- '- <br /> --------- ----- ------ ----------------------- ----- This Permit Expires 1 Year From Date Issued <br /> --------------------------- ---- <br /> a <br /> to the San Joaquin Local Health District fora No. 549 aMtex srmit to, ti g Rules and tand hRegulatonsre;n <br /> Application is hereby made jV ; <br /> described. This application is made in compliance with County Ordinance IN .- <br /> - ----- <br /> ------ _.`CENSUS TRACT -------------------------- <br /> �� v� <br /> JOB ADDRESSAOC TION --- Plaone------------------------------------- <br /> �- <br /> Owner's Name _ �C� r _ <br /> a!r�_ - c;ty c �a fes- �� <br /> Address ------------------- // hone <br /> License # fes-.� <br /> Contractor's Name --- -- - <br /> - --- - I �- cial❑Trailer Court,�❑ <br /> Installation will serve: ResidenceXApartment House <br /> _ d� <br /> Motel 0 Other ---------------- ------ ; --------------- <br /> f Ko s a./_Garba e Grinder <br /> Lot Size _. <br /> Number of living unit:-------- - I Private ❑ <br /> ' to <br /> --- ------- <br /> I Water Supply: Public System and.name --------- -- sandy Loam ❑ Clay Loarn ❑ <br /> i Silt❑ Clay .❑ !Peat❑ <br /> Character of soil to a depth of 3 feet: Sand�..,tr, - <br /> ' Hardpan ❑� Adobe Fill Material -��--- if Yes,type --------- --- - -- <br /> 1�1( Z <br /> J in �elation'to-well`s;'buildings;'e#c. must be placed on reverse side.) <br /> (plot plan, showing size of lot', liocdtion of'system U <br /> r; I I <br /> I NEW INSTALLATION: (No sept�c tank or seepage pit permitted if public sewer is available within 200 feet, <br /> I PACKAGE TREATMENT [ ] SE 1 IC TANK I J <br /> Size---- ------------ Liquid Depth <br /> j � o. Compartments <br /> nts ----------------•--f-- <br /> - <br /> Ca aciteY, --- Type - ---------- ----- M <br /> afierial--------------- Line- ----------- - W -Foundation ----------------------- Prop. <br /> o nearest: - <br /> Distanc.r Total Length .--- ------- ---------------- <br /> -------------- <br /> ------ ---;--- <br /> - . -------------- Length;a each line <br /> LEACHING LINE [ ] No�•oKines <br /> ii `D' Boxy`-__- --_-- Type Filter Material - -----------------Depth Filters Materia <br /> f' - Property Line. --------------- <br /> a --- <br /> I <br /> 4 1 YDistance to nearest: Well ------------------------ Foundation ___-_.__----.--------- <br /> 'De th -------------------- Diameter v--Y---------�`y Number --------------- <br /> Rock Filled Yes '❑ No ❑ <br /> r SEEP_ AST [ 1p , __ <br /> - <br /> Water Table Depth ---.-------- ' <br /> �-� ----- -------�-i-------Roc iZe -- ..--- -= Line ----- --------------- <br /> K <br /> r i <br /> �'Disfiance to nearest: Well ------------------------------ <br /> Date <br /> --------- ----y��--- ---- -�- Foundation <br /> id -- ----=`-�-- ----- ------ Date -------------=---------•-------- - <br /> REPAIRIADDITION(Prey.-Sanitation Permit# -------•------- , .-------- <br /> ` 3 <br /> ptic Tank [SpecifyRequ;rements) -----.- ---- },G /r� a-� <br /> w ,r 1 ! --------------- <br /> Se � . -- --- -- <br /> p Requirements) -_.__-___- <br /> -- <br /> Disposal Field [specify Re 1i _ u --------------------------------------- ----------- ------------------ <br /> q --------------- ----------- <br /> ------------- <br /> ------------ <br /> -T - 17_i �� _ ne <br /> �.,.s. <br /> " -- Draw existing and required addition on reverse side] <br /> - # <br /> ce <br /> h Son Joaquin <br /> _.—-- <br /> I hereby certif .that I have prepared finis applicati n-iitinstof theTSan Joaquin LacaloHealth District.in nHome`towner or 1 cen- <br /> t 'County Ordinances, State Laws, and Rules and Reg i , <br /> sed agents signature certifies the following: ermit is 'sued, I shat1 not employ an'person. in such manner <br /> i p <br /> "I certify that in the performance of the work for which this p <br /> as to become subiect to Workman's Compensation laws of California." <br /> Owner <br /> _ __ __ _____ <br /> f _____________________ _ t _ - y <br /> Signed ,� ,---- - - - --- ----- - ------------------------ <br /> Title -- <br /> o' <br /> . <br /> (lf otliert <br /> FOR`bEPAitTMENT USE,ONtY_ <br /> ------ <br /> AT,,� d= ' t} -----------DATE jF--�Q ",`� <br /> :.. <br /> APPLICATION ACCEPTED BY :_ - � � `- - <br /> F _ •-- -------- <br /> -------------------- <br /> ----- - <br /> BUILDING PERMIT ISSUED --------- ----- ----- ------ ---•-- ------ --#--- ¢.-- ------ --- ----- -----------------------f��, <br /> - <br /> ADDITIONAL COMMENTS - ==-Q .----7-W-- --'-1 = � - -----'fir''= � --------------------------- <br /> s ► -- -- ; - - ---- <br /> -- - 1 <br /> , t <br /> t �'r8 -Date -- <br /> ._ <br /> ----- <br /> U1N 'LOC <br /> 1� /g >J <br /> Final Inspection b �-�--�-�-- - / . -" <br /> p Y ' ° AL HEALTH DISTRICT <br /> SAN JOAQ . <br /> E. H. 9 1268 Rev. 5M. - <br />