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T- <br /> ,)R OFFICE USE: APPLICATION FOR SANITATION PERMIT 1?0-5/*19 - <br /> Permit No.. <br /> --------- - ---------------- (Complete in Triplicate) 7- <br /> Date issued ---This Permit Expires I Year From Date issued <br /> 1-73—n rk herein <br /> Local Health District for a permit to constru d install the wo <br /> -to'the an i aquin Lo <br /> IS q W 9�- <br /> Application is he.— ate No 549 and existing Rules and Regulations- <br /> described. This application is made in c9mpliance with County Or inance <br /> Or <br /> __tc�-----------CENSUS TRACT -------------- ------ <br /> . Wil' .... <br /> ----A- <br /> 'T -------- <br /> JOB ADDRESS/LOCAT <br /> Owner's Name ----- -- --------------------- <br /> City- - - I --- -------- ---- ------------------------------------------- <br /> Address ------------ ----- - -- ------6D--e- <br /> nse ------ Phone <br /> License Contractor's Name ------------ - ----I---- --------- (-ommercial ,FlTraiter Court <br /> Installation will serve: Residence F] Apartment House'[] <br /> Motel El Other 52"� <br /> - ---- -------------- <br /> Number of living units:-- --------- Number of bedrooms -__--___-__Garbage Grinder ------------ Lot Size ------Pr-Private <br /> Water <br /> --- ---- <br /> Water Supply. Public System and name --------------------------------- -------------------------------------------------------------------- <br /> t: Sancl'F� , Silt fl Clay E-] peat F-1 Sandy Loam -El Clay Loam El <br /> Character of soil to a depth of 3 fee <br /> ------------ if yes,type ---------------------------- <br /> Haed`pcin'bi Aclobe�K Fill M6terial <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 /> Size--- -- -----------------------------I---- ---- Liquid Depth .--------------------.-•--- <br /> PACKAGE TREATMENT SEPTIC TANK'I Z- <br /> • Compartments <br /> Compartments ---------- <br /> CapactY ---- --- --- Type -------------------- Material- Prop. Line ---------------7- <br /> --------------------- <br /> - <br /> Distance to nearest: Well ------------------------------------Foundation <br /> line------------ "%-- Total Length ----------- --------- <br /> LEACHING LINE No. of Lines ------------------------ Length of each - --: I........ <br /> V Box.,----i---- Type Filter Material --------------------Depth Nter' Material ------------------------------ <br /> Foundation ------------------------ Property-Line�------------------------- <br /> Distance to n"earest. Well ------------------------ <br /> I--` --------- Rock',-Fi'116d' �Nis No <br /> Depth ---------------- --- Diameter ---------------- Number .------"------------SEEPAGE PIT <br /> Water Table Depth -----------------------------------------------------Rock Size ---- ---------f--------1- -7- <br /> Foundation <br /> Prop. Line --------------------- <br /> Distance to nearest.-Well --------------------------------- --- -------------- --- - <br /> - <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------- - -------- <br /> -------------------------- Date -------------- -------------------------- <br /> Septic Tank {Specify Requirements) --------------- -------------I <br /> t---------- ---- --- ------ ---- ----- - <br /> Disposal Field (Specify Requirements) ---------21; 'Zov,------ ---------- <br /> el C>1,.X ----- --- <br /> ------- ----------------------- --------------------------- -----------------7---0----- -------------------------- ---------- <br /> -------- ---- -- - - - - ------------- ------ - - - --- ------ ---- - - -- <br /> ---------------------------------------------------- ------(Draw-existing- a n d required addition on reverse side) <br /> 1-1 <br /> i <br /> I hereby certify that I have prepared this application and that the work will be done i n <br /> accordance with Son Joaquin <br /> of the San Joaquin Local Health District. Horne owner or licen- <br /> sed agents signature certifies the following: for which this permit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work <br /> as to become subject to Workman's Compensation laws of California." <br /> d - --- --- ---------- -- ----------- -------- ---------------------------------- ----------- <br /> TitleSigned ------ - ------------------- ------- ---------------------------------------- Owner <br /> ---- --------- --------- <br /> Title <br /> By --- --------- -4- ----------------------------------- <br /> han <br /> (If oth o er OR DEPARTMENT USE ONLY <br /> ------------- <br /> ------- DATE ------ <br /> A 'Ll C I By - ------------ ----------------------------- <br /> PPLICATION ACCEPTED BY ------- ----------- ------------------------DATE _. <br /> BUILDING PERMIT ISSUED-------------------- -------- ------- <br /> .�-;Z� .Z;�------------- - ---------------- <br /> ADDITIONAL COMMENTS -------------- ------------------------------------------------------ :--—------------------ <br /> ----------------------------------------------------------------------------------- <br /> ------------------ <br /> -------------------------------------------- - --------- ------------------------------I ------------------------------------------------ ---------- <br /> ------------------------ - - ------ - -- --------- ----------------------------------- <br /> - ------ ------ -------- - -----------------------------------i------------------- <br /> ------ - --------------------------------------- -------------- ------- <br /> ----------------------------- --- - _f -1-, Dat -------------- <br /> -- ---------------- ---------- <br /> Final Inspection by: <br /> SAN JOAQ.UIN LOCAL HEALTH DISTRICT <br /> F H 9 1-'68 Rev. 5M <br />