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- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> (Cornpletp In Triplicate) ., <br /> Permit No. ... <br /> ,.. � <br /> --. .d <br /> t e Issued .:....... .....� �� <br /> ....... � This Permit Expires 1.Year from Date issueDat�� •��-,��.��� ,� �, <br /> t. <br /> Application is hereby made to the San Joaquin Local Health .Dista�or 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 /> JOB ADDRESS/LOCATION ....... f7� --- _ _ _.. lL�% .'.. �v_1� , ......._...CENSUS TRACT ....:......... <br /> `­— <br /> ..._.,�. ... ,...�.�-- 5,1ax, .. � ..Phone � <br /> Owner's Name ..... .�`.?.v./�� ��.........-•-- --•...._.....•---..,........:.......�...... � . <br /> Contractor.s Name -__- ,g. ... C,r. _ _ _:. ..-•--- ------------------License # __,_-__.._._... ----- Phone ;3G <br /> insttiiiation will serve: Residence ]Apartment House'] Commercial(]Trailer Court 0 <br /> .'� Motel ❑Other --------------------------- --------•- <br /> f � <br /> Number of living units:-I...... Number of bedrooms .....Garbage Grinder -------------Lot Size X_7...... -------=------ <br /> Water.Supply;..Public System and name ----------- ......................................... --------•------•- . ................................Private <br /> Character of soil to a depth of 3 feet:)- Sand❑ Silt o --•Clay.o Peat O Sandy Loam)'- Clay Loam o <br /> ' l { Hardpan 0 Adobe El Fill Material ............ If yes,type <br /> (Plat .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..perm.itted.if public..sewer.is.ovakiable within 200 feet3 r <br /> PACKAGE TREATMENTf ] ,,^.SEPTIC TANK I Size..' . ��� . -'6]'2..__..._.... Liquid Depth .._. ...............�}1 <br /> Cc <br /> ppatjr ------ Type/�_�.'p.C� Material......................� No. Compartments : ........... <br /> t o e k.• <br /> l Distance to neareste.Well' _.��o..............•--.-•-__--Foundation ------...---__-.. Prop. line .- <br /> .. <br /> LEACHING LINE ( j No. of Lines,.-------- --,'--- Length of each line--- ------------ ...... Total Length'- Ao:........._. <br /> 'D' Box .- ----..•- Type Filter Material/A_ _G>.A�Depth Filter Material ....../......r=Y......................... <br /> � J. A <br /> j p ri <br /> x ' . Distance to nearest: Well���............. Foundation .. --f�_.-.-:----.... Pro er Line,-.......I................ <br /> SEEPAGE PIT Depth- ------------------=- Diameter,---------------- Number ............................ Rock Filled Yes 0 No <br /> Water Table Depth ...................-'1.......................Rock Size ............................. . <br /> . .... .....: -- oundation --- ---------------- Pro Line ._..---- .--.--.-� <br /> Distance to nearest: Well -'............. <br /> REPAIR/ADDITION(Prev. Sanitation Permit#--------------------------------------!...... Date ...........-.................... <br /> --.} <br /> Septic Tank ISpecify Requirements) .................._ ......... ....................................... ---------------•----- <br /> } <br /> Disposal Field (Specify Requirements) .:. :.... - w ,� -- x ----------- ------------••-•-------•--------... <br /> f .......... ........ <br /> -------•---------------•----•-------•----------------------- •• ---••------------------ ----- <br /> --- f ----• ----- --------- ----•...--t-. ------r----..."....t..: .: <br /> (Draw existing and required,addition on rive{se sidef ; <br /> 1 hereby certify that I have.prepared this application and that the work will,be done in-accordance with San Joaquin <br /> fCounty Ordincnees, State taws, and Rules and Regulations o`f-the San .loaquin;,Local'Health District. Horne owner or )leen- <br /> sed agents signature certifies the following: `'; <br /> "I certify that in the performance of the work for which this•permit is issued,[I shall not employ any person in!such manner <br /> as to become subje to rkm Compensation laws of-California' <br /> Signed `.'' ' - Owner ( ; <br /> B --- r_..---._.-..----------.-� -- to ------------------------------------------------------ .............. <br /> (If other than owner) <br /> FOR D0ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------ ------ ------------------- DATE ._..D. �7i''"..... <br /> BUILDING PERMIT ISSUED --------------- ..__.. DATE :..._..---------------------------_ ....... <br /> ADDITIONAL COMMENTS ---•`r �"X `s'= "`�.,o:,_% ........ --------------- <br /> -- -- --•--.-----•--•-------------- . <br /> ----- <br /> - - .. <br /> Final Inspection by :.._._.. =---------------------------------------------------- ---Date _..g�� = ..._... .... <br /> EH 1,3 21.E 1-68 Rev. 5M^ SAN'JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />