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CE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> .......... ......................_:................... <br /> :7.............•� „ <br /> ........ jCornpleto in Triplicate) - <br /> ......................... ........ <br /> .. Date Issued <br /> This Permit Expires 1 Year front Oat*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 a lication is made in complir re with County Ordina ce No. 5.49 and existing Rules and Regulations: <br /> /0'f1 �� ! �',! CENSUS TRACT <br /> OB A DRESS LOC 10 G <br /> ...:.....� � <br /> Owner's Name ..�,-....:.... 1 <br /> Phone -.. <br /> Address -�.-&• . .. G�f <br /> city .........:.. ..- <br /> -C/ ......r•---.......License 40..J1 . Phone <br /> .. . <br /> Contractor's Name __. •- �'r �- <br /> Installation will serve: Residence Q Apartment House fl Commercial caller Court ] <br /> MotelQ Other .............. ...................... ...... r r <br /> eP, <br /> Number of living units_____________ Number of bedrooms Garbage Grinder Lot Size . .•- . <br /> Water Supply: Public System and name ----------------------• ---.....-..........__..... ........_........................................................Pr <br /> Ivat <br /> Character of soil to a depth of 3 feet: Sand D Silt 0 Gay ❑ " Peat{) Sandy Loam {]." Clay Loam <br /> Hardpan[] Adobe fl Fill Material ............If yes,type ................ ............ <br /> • <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: INo septic tank or seepage pit permitted ifpublic pewer.is vaHgble within 244 feet,] -�' <br /> _ <br /> Liquid Depth _ r �.... . ... a <br /> PACKAGE TREATMENT [ I SEPTIC NK ] <br /> > t <br /> Capacity <br /> - ---- Type Material.. c -= _ No.:Compartments° <br /> Distance 'to "nearest: Well ....-•-•••-••--•--.... ••Foundation _-•.•..••------ Prop.. Line . <br /> :. iIK24-10......... y. <br /> LEACHING LINE { ] No. of lines -�(• Length of each line- ��•.-•••............•• Tota( Length <br /> -- <br /> r 'D' Box :.---- Type Filter Material ." _- Depth Filter Material . . ...... <br /> Distance to neargst: Well ........................ Foundation ..-..................... Property Lina ........_.............•. <br /> s <br /> ....... Diameter �'E ..---•-•-- Number,../4•-•.. ............ Rock Filled Yets No �� <br /> Depth*^� SEEPAGE PIT [ l � p ,�••�-- " <br /> Water Table Depth ................................Rock Size ..................................Pr p Li <br /> ._Foundation <br /> - Distance to nearest: Well - (� o ne .................... <br /> - <br /> tr . <br /> «.+s REPAIR/ADDITION(Prev. Sanitation Permit# ...... Date --.----•-- _••........:...... ] <br /> ....... <br /> Septic Tank (Specify Requirements] .......................`--.. <br /> Disposal` Field (Specify Requirements] ------------------f a . <br /> a. <br /> ----------------------------- <br /> ., (Draw existing and required addition on reverse side) <br /> 1 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. Homo owner or licen- <br /> '`� sed agents signature certifies the following: <br /> "I certify that in the performante of the work for which this permit is issued, i shatl not employ any person:In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed - ------- --.... - •-- •---•----- ---• --••--------------- ----- Owner <br /> B Title ------------- -. --- <br /> . (I of er ow erl <br /> R P MENT USE ONLY <br /> APPLICATION ACCEPTE© BY .-_7` ..... ........ .. " . ............ DATE <br /> BUILDING PERMIT ISSUED :._:.� '..::.:__: _ AT - - :..._:. <br /> ' ADDi 4MME <br /> !� <br /> t- <br /> ' <br /> Date <br /> Final Inspect on b •- --- �.�_� <br /> EH-13 ;24 1•-66 Rev. 5M SAN JOAQUIN LOCAL H LTH DISTRICT 8/74 3M <br />