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FOR OFFICE USE:- -.�. .� - � �- <br /> J ApPLICAT_lOM FOR SANITATION PERMIT <br /> ----- ------------- ------------ - <br /> Permit No: �,1) <br /> - (Complete in Triplicate) <br /> E, Date Issued -l------- ------- <br /> This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Hqp6lth District for a permit to construct and install the work herein <br /> described. This application is made in compliance,wi sC ntv r,- inance No. 549 -and existin Rules and Regulations: <br /> 6609 <br /> JOB ADDRESS LOCATION . tE' --- <.r- l-r.!'_ �_ x �1 . ---Z/V i <--- --- .__CENSUS TRACT -`------------------------ i <br /> Owner's Name --- � h�? [�` =`' =- --- -------•------------------- ------------------ -------------------Phone <br /> ` <br /> ••Fr---.-�---G---_-.-.-.- <br /> Address ---6.,K,?-s------- ----------- --------- City --- - <br /> r# - <br /> � --- Licens ---- Phone ---GContractor's Name -.. <br /> Installation . <br /> will serve: Residence ❑Apartment House,❑,Cornmercial�❑Trailer Court '❑ <br /> Motel ❑Other -------------------------------------------- <br /> Number of living units:------- Number of bedrooms - ______Garbage Grinder 7_._ Lot Size oijlf "-'�Q-'-- ------•••- <br /> Water Supply: Public System and name ---------------------- ----------- ------------------------------ -----------------------------------------Private E]Character of soil to a depth of 3 feet: Sand'0' ' Sift❑ Clay '. Peat E] Sandy Loam ❑ Gay Loam ❑ <br /> Hardpan ❑ Adobe' Fill Material yXI7___ If yes, type ---------------------------- <br /> (Plot <br /> ________________-_______ -(Plot plan, showing size of lot,.location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW r is available within 200 feet,A) f <br /> if y <br /> PACKAGE ATREATM NT {No sSEPTIC TANK.[y} pa a pit permitteedb sews Liquid Depth ------------------- <br /> I <br /> b1 <br /> �` <br /> __ Material___ k�___- No. Com artments ____ <br /> Capacity -�� ---- Type =. -- p �� <br /> Distance to nearest: Well __�J-�_______________Foundation ______' _______ Prop. Line ___ ____._.__:____.... <br /> LEACHING LINE [j,--N—o. of Lines __. --------------- Lengthy of:aa ch line____ _ -- _- Total Length .............. <br /> 'D' Box Type Filter Material' X-4."_______Depth Filter Material --------- ---�_-__��___________------------ <br /> Distance ronearest: Wel! ---------- Foundation --.- --------- Property Line -- -------------- <br /> SEEPAGE PIT [ Depth 1)..i"_'______ Diameter . -1-`__ Number ______ _. ----------- Rock Filled Yes � Na C <br /> j� I / <br /> Water Table Depth ------- //___f `y -------------Rock Size -__ __ <br /> Distance to nearest: Well _-, � -a----_--- __________Foundation -- _`...... Prop. Line _.._....._.__ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------_----.----------------} <br /> Septic Tank (Specify Requirements) ---- ----------------------- --------------------------------------••------------------- ------ i <br /> DisposalField {Specify Requirements) ------- ------------------------------------------------I---J---------------------------------------------------------- --------------- <br /> I <br /> ------------------------- -------------'------------------------------------------------------------ I <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;Stote`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 Ccflifornia." <br /> Signed -------t-------- ---- --- ------------------- -------------------------------.1 <br /> ---- --------------f ' Owner <br /> BY -------------------- t e /----- ----------------------- <br /> T i I �- u <br /> er <br /> FOR DEPARTMENT USE ONLY of <br /> APPLICATION ACCEPTED BY --------- ;-__ -. DATE ------ <br /> ----- -- --.7�r <br /> - ----------- <br /> BUILDINGPERMIT ISSUED --------------------------------- -------------------:------------------ = ------DATE --------- --------------------------------.. <br /> ADDITIONAL COMMENTS = -`------------------------ ----------------- j - <br /> ----------------------------------------------------------- -- - - ---------------- ----- ----- --.:-, <br /> __ w .Y _ . ...� - <br /> ------------ --- ----------------- ---- ----- ------ <br /> ------------------------------ - -:------ ------------ _------ -- -_----- ---- --- ---- ---------- ---- -------- ----- _ , -----------_--- <br /> FinalInspection.by:._-.- ---------------------------------------------------------v-,.-. •------- -------.Date --------------------- <br /> $: SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> `0✓ <br /> E. H. 9 1-'68 Rev. 5M <br />