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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> t' .. <br /> _.[Campletele Tsiplicatei . , Permit No.�7,.5.::-.S .�. <br /> ... ...---•--........--•--- This Permit I Year From Date = Date Issued _�Z�:.�.� <br /> .. <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 application is made in compliance with County Ordinance No. 549 and _existing Rules and Regulations: <br /> i <br /> [� ... <br /> .l �. A" <br /> JOB ADDRi:SS/iDCATiON .._ .. ... ..:............:. CENSUS TRACT ............................ <br /> Owner's Name -x? 11, •• ........ Phone . ........................... <br /> --.. <br /> Address ------� ,Jjr, ter.- -..... _ I...................... ....................... City s a ..........:................._.......................... <br /> Contractor's Name -------- l............:.......License 9l& �" �! Phone 1 �� <br /> 6 - <br /> Installation will serve. Residence Apartment House(-] Commercial OTraller Court [3, <br /> Motel Q Other--------- .................................... L <br /> Number-of living units:---. .... Number of bedrooms?.x _.__Garbage Grinder,4.14.. Lot Size �..��.�.r�✓�.�. :..:............. <br /> Water Supply: Public System and name 4........ ..................� !a ............ ........... .:...__.................._...........Private. <br /> Character of soil to a depth of 3 feet. Sand 0 Slit 0 1k Clay 0 Peat❑ Sandy Loam Q Clay Loam❑ <br /> Hardpan fl . Adobe Fill Matwlal ............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 ] size......:......................................... Liquid Depth ............................ <br /> Capacity - Type .: Material.............:....:. No. Compartmer+ts <br /> = .................. .................... <br /> ,. <br /> P Distance.to nearest: Well ............:.......................Foundation ...................... Prop. Line <br /> LEACHING LINE ( ] No. of Lines ....... ....... Length of each line............................. Total length ........................... <br /> 'Q' Box�.....----, Type Filter Material ....... ..0epth filteraterlal ..- <br /> ..... --- --�^ -- <br /> 1. Distance to nearest: Well .............. .4....... Foundation I Property Eine ----.- _-.- <br /> SEEPAGE PIT [ } Depth - ------------ ----- Diameter ! Rock Filled Yes Q No 0 <br /> :. Number ... <br /> 1Water Tbe Depth ......................:.....Rock Size --•-•-----• z <br /> ................ i <br /> Distancelto nearest. Weil <br /> •----•.................._.....-•---... foundation ------•----t�-•------ Prop: Line ...................... <br /> REPAIR ADDITION(Prev. Sanitation Permits .._ I <br /> Date _.._.................. . .. <br /> Septic Tank (Specify Requirements) ............. S <br /> ...... .............::.::.:...........:..:...:......:.:..:... :....._.. .....- .:........-- - <br /> Disposal Field (Specify Requirements) ..-/ <br /> ---------------------------------------------------------------------------- •-•---•-----•------- ----............ - ... <br /> • y a" <br /> �.� <br /> -•-----• ---ti -- ---- • . ............. •• ...._ --.... -....----------- -- --- ,, ......... <br /> (Draw existing and required addition on reverse side(. . r <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquln <br /> County Ordinances, State Laws, and. Rules and•Regulations of the San Joaquin Local Health,District. Horne owner or licen- <br /> sed agents signature certifies the following <br /> "I certify that in the performance of the work for which thisrpe-rmit Is issued, 1 shall not employ any person in such.mgnrier- <br /> j as to become subject to Workman's Compensation laws of California." <br /> I: Signed ----------------- --- ---------------- - --•- -------------­---------- Owner <br /> -By ....... -•-•--. .. ,�._..---•--•---•--------------- - Yitle -- .......... <br /> +' E <br /> er than,ownerl <br /> FCODEPARth(ENT USE ONLY , <br /> APPLICATION ACCEPTED BY� ti <br /> BUILDING PERMIT ISSUED ................................................... .......................... <br /> -----------------DATE ----------............................... <br /> .. <br /> r <br /> ADDITIONAL COMMENTS ---------i.........................._..........-�---•-- •- -� •- -• �.V• ���• • 7—� � _ ........., ... <br /> ------------------------------------------------ <br /> ------------------- <br /> ---•.......:..... --• ---------... • ... �. <br /> .... ......... <br /> ----------------------------- -------------------- <br /> ............ <br /> - �? .. <br /> finai Ins ection b .�---------------- - --i---•---•----••--•------ - - - .. -------......Date .....- ----------- ................ <br /> iii 13 24 1-68 Kerr. 5HSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />