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' FOR OFFICE USE- <br /> APPLICATION ICOR SANITATION PERMIT <br /> .......................... <br /> ..•------- .............. rylCoenirlete In Tilpficate3. Permit No. . <br /> . .t .. .. <br /> � ................... ......... <br /> Date Issued �"�•��' <br /> ........................................__•-----...._---•. This Peimitfxpir`es t Year From Date issued <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 mode.in compliance with County Ordinance No. 5:49 and existing Rules and Regulations: <br /> Job ADDRE5S/LOC TIO .. G.� : -•-. .W. ....--. ..v .......CENSl15 TRACT ..._,..................... <br /> -� <br /> �. Owner's Name _ *7.11Q� PhoneVA-077 0� --- <br /> Address . ,..Q ........... City ...................:................. <br /> Contractor's Name ._.License # ..:.........:........... Phone - <br /> - ._..... <br /> Installation will serve: ResidenceApartment House Commercial OTrailer Court 0 <br /> Motel []Other <br /> Number of living units:�.� Number of bedrooms Garbage Grinder Lot Size ,�, � <br /> ..... ----........ <br /> Water Supply: Public-System and name. ..... __:.. .fir !--....__................................... ..Private Q. <br /> t <br /> Choracter of soil to a depth of 3 feet: Sand 0 Silt C] Clay Peat❑ Sandy Loam {] Clay Loam 0 <br /> Hardpan 0 Adobeig Fill Materlal ............If yes,type............... ............ <br /> )Plot plan, showing size of lot, location `of system In relation to wells, buildings `eft. must.be placed on reverse side.) <br /> NEIN INSTALLATION: (No septic tank or seepage pit ,permitted If public sewer is available within 200 feet,)' <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] q pth �p <br /> _ Size................................................ Liquid De ..._......._...... <br /> Capacity, = ._... Type .................... Material---------------------- No. Compartments ..................... <br /> F <br /> Distance,to, nearest: Well ..............Foundation - __-.-__.:..... Prop. Line <br /> I LEACHING LINE [ ] No. of Lines .....................:.. Length of each line............................ Total Length ............................ <br /> D' Box Type Filter Material ....................Depth Filter Material -------.------•---- ....................... <br /> k a <br /> Distance to nearest: Well _._._ Foundation -_--. Properly rty Line <br /> SEEPAGE PIT [ Depth .................... Diameter ......... Number .......------------------... Rock Filled Yes Q No Qom. <br /> Water Table Depth ..................Rock Size ................................. = , <br /> . Distance to nearest: Well ---...._--_.•----Q....................Foundation ..................... Prop. Line .... .................f <br /> r REPAIR/ADDITION(Prev. Sanitation Permit __I- _o ..................... Date .-7'z.7--64 _) <br /> t <br /> te......_.:r..Septic Tank (Specify Requirements) .................. <br /> ..f Disposal Field lS ecify Requirements) ------ -- - ----- -- ?----- �exJ <br /> .---------•------•----•-------------------------------------------------------------------------------------_...------.......--• .................. ------------- ---.....------..--- ................ <br /> s (Draw existing and required addition on-reverse.side) <br /> I hereby certify that I have prepaireil this application and that the work:will be Bono.in atcerdance with Saiz Joaquin <br /> i County Ordinances, State Law's,`and Rules and 'Regulations of the San Jaa urn Local Heal&,District. Nome owner or licett- <br /> sed agents signature certifies the'fellowing: <br /> "I certify that in the performance-of the work for which this permit is issued, I shall notemploy any person in such manner <br /> as to becom Lbject to Waran's Compensation laws of California." <br /> Signed _.. ------------- --------------_--- Owner <br /> By -•---------------------- <br /> .. Title <br /> i (if other` than owner) <br /> FOR DEPARTMENT USE ONL r <br /> APPLICATION ACCEPTED . _ -•- _ •-., -• .t__.._.-._. . <br /> - - •- ---- - . --- - --- -- - ----------------=-•--•--. .DATE _.`-_ �'-' <br /> BUILDING PERMIT ISSUED .......................... .......................DATE ....__.. ................................ <br /> :: <br /> ADDITIONAL COM NTS ................. <br /> ----------------------- ._K. . �_.__A: _: <br /> --------------______-------- _ - ------- . ----- _ r -_____ _. _ . <br /> 1 Final inspection by: ........__--- -_-- 1­1Date .: . ._ . <br /> J. <br /> '' ,, Eli 13 2b 1-68 Nev. 5M S N JOAQUIN CAL HEALTH DISTRICT 8/74 . 3M <br />