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+ FOR OFFICE USE: APPLICATION FOR SANITATION PI°RMIT <br /> Permit No.`�- •"' /� ' <br /> ......... (Complete in Triplicate) ' <br /> Date Issued <br /> ...... .............. <br />:..................................................... <br /> This Permit Expires 7 Year From Date Issue <br /> A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> pP application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> described. This app <br /> ....................CENSUS TRACT <br /> .......... <br /> JOB ADDRESS/LOCATION, �•y,�/�----- ....:.... <br /> Name .�--••r-�•��'`--`��-_...��sC� .......,. .----•------. .f-• • .-•---pho� ................................... <br /> Owner's {� City (` ....... <br /> .. . <br /> Address ......... T .._.....- Cense Phone ..... ......... <br /> �] r l �/] <br /> Contractor's Name ........4:/ -- <br /> Installation will serve: Resident Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other ........................................... Q�t�.� <br /> 1 dam`•-----• , i <br /> Number of living units:...__(..--- Number of bedrooms _.y.•,Garbage Grinder -__._..._... Lot Size ...............••----••• <br /> .......Private <br /> Water Supply: Public System and name ............••.............. ...........•--­----------­ <br /> C] <br /> -"- - Sandy Loam Y Loam D <br /> Peat <br /> Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ ❑ Clay <br /> HardpanE] Adobe C] .Fill Material ............ if yes,typ <br />+ of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing site of lot, location <br />' ewer is available within 20(3 feet,) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public s <br /> >C . Liquid De th <br /> SEPTIC TANK <br /> PACKAGE TREATMENT [ <br /> X...... p <br /> ts <br /> Capacity . . G. -- Type <br /> � Material__(Pv" ..... r <br /> � <br /> Distance to nearest: Well .�-`-°--�--•-•--•---- <br /> ..Foundation /..a .. prop. Line ...... ............ ., <br /> f <br /> . Total Length ._..�p................ <br /> ks <br /> ....--•-_-- Length of each line........ ........:._...... <br /> LEACHING LINE [ No. of Lines ------ �� ...._.. <br /> ../e. Depth Filter Material ----..�1...__ <br /> 'D' Box `=-.. Type Filter Material ................ ..• P <br /> f 5' <br /> ! .....--•-- Property Line ..... <br /> Distance to nearest: Well .......... ............. Foundation ....._.... <br /> �— '-� Number 1....----••• Rock Filled Yes No ❑ <br /> ------ <br /> Water <br /> ...../g, e er ,---• -- M <br /> •-•----�� .Rock Size .. <br /> Water Table Depth •---�a---•--•-•-••--•--••--••-• �. ..?.....lr.-... - i <br /> Distance to nearest.• Well <br /> o Foundation ...L.D............ Prop. Line ....��.............. O <br /> - �-•-_•-•••---•••••--••---- <br /> RiEPAIR/ADDITION(Prev. Sanitation Permit# ---- <br /> Dote ............................ ...... ) <br /> Septic Tank (specify Requirements) .......................• <br /> ----------- ••--------------- ------- ---- <br /> Disposal Field (Specify Requirements) -----•-•-----••--------•---••••....................... <br /> ...•--••- <br /> -----• ------ ----------•.................................... .. <br /> ----...._..._..-----•••--•----•---•--... ---•------.....---.....--•------. ..-----...---.. <br /> 4 ...................................................__..__.. __........... .._........................-_._ <br /> .......................................� , (Draw existing and required addition on reverse sie <br /> hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> I I her <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liten- <br /> sed agents signature certifies the following: permit is issued, I shall not employ any person In such manner <br /> "I certify that in the performance of the work for which this <br /> as to become subject to Workman's Compensation laws of California." I <br /> k ---___-• Owner <br /> Signed <br /> r�-Q------ Title .------••' -------•----'--=•-•----'--•-------•................. <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> .. DATE ../�_"' .............. .............. <br /> .........................•-----.....---..............._-•• DATE <br /> APPLICATION ACCEPTED BY . ... .:.. ... ..•-•--••----... ............................................ ..---••--- <br /> BUILDING PERMIT ISSUED ...............•----•--•----•-•-••-.._...---- -----......----•-----.....--- <br /> ADDiTIONAL COMMENTS ............................................................ <br /> ................. ........ <br /> VSAJOAQUIN , <br /> -----•-----------•-----•- . <br /> . <br /> I <br /> •-----------•------------------- <br /> ..__..Dasa <br /> Final inspection by: -•�--� <br /> LOCAL HEALTH DISTRICT <br /> 7/72 3,M <br /> n,.. 9AA _ _ <br />