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fOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> __1?7---------------- ---- --- <br /> Permit No.; <br /> (Complete in Triplicate) <br /> - ------ --- ------------------ RV.,30-------- <br /> ij. E- Date issued .2�� ---?1n6,? <br /> ----------- -----------------------------:----------- This.permit Expires 1 Year From Date Issued <br /> Appi icati6n-i s-hereby madii'to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This applicdtionlis_macle in compliance with County Ordinance No. 549 and existing Rul-es and Regulations: <br /> JOB ADDRESS/LOCATION - - ------ - ----- ----- ------------------------------ ---- -_CENSUS TRACT --------------------_---- <br /> 13 A <br /> __.11�-' Phone ---------- ------------------------- <br /> ------------- ---------- - ---- --- - <br /> --------------- ------ `"`_'Name ------- <br /> Addres's P. --------------Z------------------ -------- <br /> Phone ------- ------------ <br /> Contractor's Name -- -------- ------ ----- --- ------ - -------__.License <br /> Installation will serve., R*esi' ence Apartment House,[] Commercial E]Trailer Court 'E] <br /> t II Motel F1 Other ------------------------------------------ <br /> Number of living units:---- ------ Number of bedrooms cpll___.Garbage Grinder ------------ Lot --------- <br /> Water Supply: Public System and name -------------------------------------------------------------------------------------------------/I r-------------Private <br /> Character of soil to a depth of 3 feet: Sand'[] Silt E:1 ClEl Peat E] Sandy Locim [I Clay,Loam <br /> I Hardpan F , Adobe rFill Material ------------ If yes, type ------------------------- <br /> jPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse. side) SN' <br /> NEW INSTALLATION: (No septic tank or se7ege pit permitted if public sewer is available within 200 feet,) -- <br /> PACKAGE TREATMENT K�[SEPTIC Size4_;"/r/P1X ------------------ Liquid Depth -- ---------- <br /> Z_ <br /> P Material No. Compartments <br /> Ca acit ,,,Type - -------- - ---- :m----­-­------ <br /> .0 <br /> Di t -ndafion -------h__-____-- <br /> nce to -ne rest: Well,11� ------------------ -.,Foti Prop. Line ------------ <br /> / /_ 7'-tg� line�.f -- ------ Total Length _J�g-____:__---.---__ <br /> .. <br /> �CHING LINE, I K.I of Lines ------- -------------- Length of eachTilter. Material --------------------------_ <br /> D',j Box r-MA Type.Filter Material— Depth�_? <br /> erty, Line-.-r--.- ' <br /> Distance to nearest: Well--7SZ�-------- Foundation','.- Prop --------- <br /> SEEPAGE PIT De_'pti%Crk-4` No 0 <br /> Number ----- ----------- - Rock Filled Yes g3 <br /> ater Table Depth^_'­------- ------ ._...Rock Size ---- ------- <br /> ------------ <br /> Distance to nearest: Well -----------hl��---------------- Foundation ----/_-,V-----_---. P I rop. Line -------------•-•------ <br /> II <br /> REPAIRJADDITION <br /> ---------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------- --------------------------------- Date -----------------------=------------ <br /> I Septic Tank (Specify Re6birements) ---------------------------------------- ---------------------------------------- ------------------------------ ----------------X---------- <br /> ________..._ ------------------------------------------------------ ------4�-—-----------------------------------1.'----------- <br /> Disposal Field (Specify Requirements) <br /> ------------------------ <br /> ----------------j-------------------------------------------------------------------------------------------------------------v------------------------ <br /> ------------------------------------------------------------------- <br /> ---------- ----------- --------- --------------- ----------------------------------------------------------------------- <br /> jl)rai;�'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 /> r -i 4 <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifie's the following.- <br /> "I certify that in the performance, of the work for which this permit is issued,.1/shall not employ any person in such manner <br /> as to become subject to Workman's.Comp6nsation laws of California." <br /> Signed ------------------------"7: Owner <br /> -----------------------"7: Owner <br /> By ------------- - -------- - ------------------------------ Title ------ ----------------------------------- <br /> ilf other than'owner) <br /> FO) DEPARTMENT USE"ONLY <br /> APPLICATION ACCEPTED BY ----------------- DATE --- -- -- --------- --------- <br /> "-- -------�r-----—------- -------------------------------------- <br /> BUILDINGPERMIT ISSUEDI------------------------------------------ -------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS '------------------------------------------------------------------------------ ----------------------------------------------------- --------------------------- <br /> .1 <br /> -----------------------------------------------------------------------------------------r------------------------------------------------ ------------- ------------------------------------------------- <br /> 11 <br /> ----------------- -- ------------------------------- -------------------------------------------------------------------- -:--------------------------------------------------------------------------- <br /> -------------------------- ---- - ------------------------------------------- -------------------------:---------------- ------------------- <br /> : ------------------------------------------Date-:------ ---- ------------------- <br /> Final Anipection by <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M,ili <br />