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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -- -------7--------------------------- <br /> ------ Per"mit No. ------- <br /> (Complete in Triplicate) <br /> ----------- --------------------------- ----------------- Date Issued J�?�--------------- <br /> 0! 7).- <br /> ate Issued <br /> This Permit E�koiies 1 Year From D <br /> ------------------------------------:--------------- <br /> V !io construct 4n, <br /> Application is hereby made to the San Joaquin Local Health District for a permit I install the work herein <br /> described. This application is made in compliance with County Ordinance No..549 and existing Rules and Regulations. <br /> oil <br /> - ) I CT --- <br /> 7y'7t -, ----------- <br /> JOB ADDRESS/LOCATION ------- -- 14 W_1-1 �CENSUS TRA <br /> ------ 47 <br /> Owner's Name ---- --------- R------------------------------------------7x__�.._Phone <br /> Address 23 -------M-6-n-way--------c7_4---------------------- city ------------------------------ <br /> ------ <br /> ------ <br /> Contractor's Name ----61VH_VR-- ----------------------------------------------------------------License # ----_--------------- -- Phone ------- ----------------- <br /> _'Ri_sFdence [e�Apartment House Court <br /> Installation will serve; ur <br /> r -2 <br /> Motel ❑other ---- ----- -------------------------------- <br /> d Number of living units:--S— S -_____Garbage GrinderNa---- Lot Size AC_R 946-�F— ------------ <br /> --------- Number of bedroom ---- --- <br /> Water Supply. Public System and Pame ---------------------- -----------------------------------------Private <br /> and Loam <br /> CIpy. E] Peat 1::] Loa rn,.2�qom <br /> Character of soil to a depth of 3 feet: Sand'E] Silt E] <br /> Hardpan E] Adobe <br /> El mEill Material If yes,type-------------------------- <br /> (Plot plan, showing sizjf lot, locath f system in rt to wells, buildings, etc, must be-place�,R!),rdverse side.) <br /> i 1 0 0 1 1 j _\ . F�, k <br /> NEW INSTALLATION: (No septic tank r seepage pit permitt6d if public sewer is av ilable within 200 feet,) <br /> PACKAGE TREATMENT [j SEPTIC TA Kf f Size------------------------- ------ ---------- Liquid Depth ------------------ <br /> rial---- --- ----------- -- No. Compartments_ ---------0.... <br /> cbpacity ------ -- ------- Type ------ ------------ Mate <br /> Distance to h. are'st. Well <br /> ------------------ --------------- Foundation -- ----------------- Prop. Line ------- <br /> sl <br /> Length�k4�-f L%- <br /> LEACHING LINE No. of Line ------------- eachSine------------------- ------ Total Length .-------------------i.,...... <br /> 'Y <br /> 'D' Box ------- Type FilteriMaterial 11__---_-__--t7-___Depth Filter Material -------------------- -------------- <br /> I- - . — <br /> LDistance-to-n rest: Well --- ---------------- Fount'dation .----------- ----- ----- Property Line ----j;C <br /> C/ <br /> SEEPAGE PIT Depth Diameter ---------------- Nurnber _:-------------- ---------- Rock Filled Yes N 01C, <br /> at <br /> Water..Table- pth-N-------------- -=----Rock Size --- - -------------------------- <br /> Distance-to n rest-Well -----------ji�__.,'­Foundation -------N----------- Prop. Line ------­------------- <br /> �1 e I i Ily <br /> ----------------------- ; <br /> REPAIR/ADDITION(Prev. Scinitati' n Pemite# ----------------------------- ---------- --------- <br /> Date ------ <br /> ---------------*---------------- --------------------- <br /> i re ts) . -EX- 7- iq i L <br /> -------------------------------------- <br /> Septic Tank (Specify Requirements) 4i- <br /> Disposal Field (Specify Requirements), 71-------- ------------------------ <br /> DIST- ------------ ---- ZjEac�--------- --- -------------------------------------- --------------------- <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 doneinaccordance with.San Joaquin <br /> County Ordinances, State LOWSr and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed <br /> sed agents signature certifies the followiing: <br /> "I certify t t *n the e once of t6p' work for which this permit is issued, I shall not employ any person in such manner <br /> as to bec uble orkman's qamAnsati*n laws of California." <br /> Signed Y_ --- ------- -------------- Owner <br /> t�_R_0. <br /> Title --------- -------------------------------- ---- ------------------- <br /> By ----------------------------------------- <br /> (if other than owner]{ <br /> 7� <br /> FOR DEPARTMENT USE ONt <br /> APPLICATION ACCEPTED BY ------- - ----------------------f?------------------------------------ -------------. DATE ------ ----- <br /> > <br /> BUILDINGPERMIT ISSUED ----------I-------------------------------------------------------------------------I V-------- ----------DATE --------- -------------------------------- <br /> ADDITIONAL COMMENTS ------ -- ---- ------------------------ ---------- - --------------- --------------------------------------- ----•--• :------------- <br /> -""I <br /> "_"N*"'L v"v'r <br /> ----------------------------------------- ---- ----- - ------------ -- ----- ------ -- ----------------------------------------- ------------------------------ <br /> -------------------- -------------- --- ------- -------------------- -- ------ --- - - -----------::------------------- ------------------------s----------- <br /> i------ ------- --- -- -------- ---- ------------------------------------------------------- <br /> ----------------- ""j............... ..... ---- ------ - <br /> - -- <br /> Inspection ------ -------------- --------Date ------ <br /> W I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. H. 9 1'-'68 Rev. 5M <br />