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r } FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..... ------•...........................:.. <br /> • --••--------- ----- <br /> r ._ ... �:w .. . . <br /> ��- .:AAAA,._ �. " IComplete.in Triplicates _.._ .- ._ v <br /> Permit No 7 �7� <br /> ti........................................•--•-• <br />►' ........... TM*Permit Expires t Year from Date Issued Date Issued .......��_.T6 <br /> ..........................•--------... _ �3�-•-032 --� -� <br /> Application is hereby made to the San Joaquin Local Health District for a permit construct and install the work herein <br /> described. This application is ade 12 compliance with County din nce 9 and existing Rules and Reguliations- <br /> JOB ADDRESS/LOCATI N ...CENSUS TRACT <br /> ¢ .: - ... <br /> Owner's Name _.._. . ---•--------•............................ ..................:.....................Phone --............................... <br /> 3 <br /> AddressGam#? ._.._... ,..._._............... ..:. .........:.............city _...__A............................................... <br /> 1 <br /> 1 Contractor's Name ---.1�-- ,;J;77 <br /> AAAA- ........................License# IF.� ..._ Phone?J -L <br /> i Installation will serve: Residence[]Apartment House El Commercial OTrailer Court 0 <br /> k Motel p Other.. <br /> • <br /> Number of living units:....I.___- Number of bedrooms Garbage Grinder lot Size <br /> i - <br /> ---•----••-- -•...................•-------AAAA._.__. <br /> Water Supply: Public System and name .................................._.....................-•----.._...........-•----......._....................Private 0 <br /> Character of soil to a depth of 3 feet: Sand'j] S€It o Clay Q Peat 0 Sandy Loom Clay Loam ❑ <br /> Hardpan Q - Adobe 0 Fill Material ............ 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 TANK I I Size---_...---._._-•......................... Liquid Depth -_---_-_----------- <br /> Capacity <br /> _--... -_--_._ ---Capacity .... ............... Type .....----..:........ Material...................... No. Compartments •------------ ---. <br /> t <br /> Distance to nearest: Well ...............................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE ( ] No. of lines ------------------------ Length of each line................... Total Length ......._.................... <br /> D� Box ............ Type Filter Material .........AAAA_......Depth Filter Material -----------------------AAAA.---..---._------ <br /> pistance to nearest: Well .............. .. Foundation .......... Property Eine ...................... <br /> ..._AAAA .......... <br /> Rock Filled Yes)k No ip <br /> -3€�•,413Ef [ I Depth /.)_(/,9-A30Diameter ---•-----------. Number ----------- ----------- •-• <br /> Q � <br /> �6t �J Water Table Depth .......... ....................................Rack Size - <br /> /-,/A......... <br /> Distance to nearest: Well ........................................foundation .................... Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# ........I---------.................... Date ........_...........____...__.--_-} ...-----.-_. <br /> I -- <br /> Septic Tank (Specify Reguirementsl -----------------------------------...:............:....::...•-------•--=--------.._.------------•-•-•---...........--...--•-•------ I- <br /> DisposalField (Specify (Requirements) --•-• ............. ........................ ........._..................................--.. ----•-•--•----•---._....... <br /> ----------------------------------- _ . <br /> --------------------- I� ---- ------ --------------------. --. ...... .-•---- <br /> ----- ------------ ...............................__ ... ----.. <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, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Hone owner or 11cen- <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 California." <br /> Signed AAAA -_ -Y ------- Owner <br /> . AAAA.. ... . <br /> By �J� Title - ........................................... <br /> ----- ------ ---- - ---- .._ .. 1. - <br /> C If her hon,o ne <br /> FOR DEPARTM S NLY <br /> APPLICATION ACCEPTED .SY..•.: - G = <br /> `_.,DATE ... _. .. ,. <br /> BUILDING PERMIT ISSUtD�--------------------------- .-------.----_.DATE .....-_._.__-_._ <br /> -----------------•----••--- AAAA.--- ._........--•---- - ------- • - ._._......-----•----- <br /> ADDITIONALCOMMENTS°--------............................................................................................. ........_..-....--------------------------------------- <br /> ii <br /> -------------------- --• -- -----------------------•-•-----------------------.._._.__.....-------•----------......_...-•------------------------ ---- - •-• ............................................ <br /> ------------------------ '!.._.. - --------------------------------------- <br /> -------+---------------------......-.........-.. ....... .................................. <br /> - AAAA... <br /> •----------------------------• ----- •---.ii. ---- .---...---•--•-----------•---------- ---- <br /> Final Inspection by: .-------- ------- ----Date ... . . . <br /> EH 13 2a 1--68 lay." 51 4NJOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />