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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -----------------/Z'-`.z' Permit No. L- ------ <br /> (Complete in Triplicate) <br /> ---------------------------------------------- <br /> ------------------------------------ This Permit Expires 1 Year From Date Issued Date 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .___--- /i -! ----- Y_All_....�0 r I-------- -- ----------CENSUS TRACT ---- - --------- <br /> 'P <br /> Owner's Name _.__ � _ _ B. Phone ----- <br /> Address ------- t --------------=------------------------------------------------- City --------------- ------•----------------------- -------------_--- <br /> Contractor's Name ---------- ------------------------------------------------License # ------------------------ Phone ------------------••---------- <br /> Installation will serve: Residence ❑ Apartment House,❑ l Commercia []Trailer Court <br /> raer our ;❑ <br /> � <br /> Motel ❑ Other ----- Ina b lam ��-✓+/� <br /> Number of living units:__________ Number of bedrooms _-----Garbage Grinder _=� -- Lot Size - _ _J_'_- l' -✓�------- � <br /> Water Supply: Public System and name ---------- J-a--2, P ---------------------------------------------------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam <br /> Hardpan ❑ Adobe '❑ Fill Material ------ 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 [ I SEPTIC TANK: � Size____? �____-!!� -------------- Liquid Depth -----G/__�=----- <br /> Capacity ,2 Qr�_�'_= Type/�i^�''__�� a#erial__ __ o. Compartments --______-__ <br /> Distance to nearest: Well ------� ------------------Foundation ---- ------ Prop. Line--------- ----- - <br /> LEACHING LINE jX No. of Lines -- -e-1 Length of each line______� _�____---- Total Length __.� -1_._.___ <br /> 5, ! o c� <br /> 'D' Box -[.�'=__ Type Fitter Material r _ _____________Dept�i �i�ter Material -_--����--------•--�------•---- <br /> Distance to nearest: Well ____U___S }___________ Foundation ___�. _ _ Property Line <br /> Pro .��--------••----- <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No 0 <br /> WaterTable Depth ----------------------------------- ------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ....----..------------ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _______-------.-------------------) <br /> Septic Tank (Specify Requirements) --------------------------- ----------------•--------------------------------- <br /> Disposal Field (Specify Requirements) ----------- --------------------------------------------------------------------------------'---------------------------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <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 done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: :.� <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject tgE Workman's C�rnnensation laws of California." <br /> Signed 4zOw <br /> ner <br /> By --------------- ------- ---------------- --- ------------------------------------- Title ------------------------------------------ ---------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -. _ __ <br /> 1 ------ DATE . 7Z <br /> BUILDING PERMIT ISSUED ----- ----------------- <br /> -- --- ---------- DATE <br /> ADDITIONAL COMMENTS - ---- ----------------------------------- - ----------------------------------------------------------------- -------- ---------------------------------- <br /> ---------------------------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------- <br /> ----------------------------------AM <br /> --- -- -------------------------------------------------------------------------------------------------------------------------------------- <br /> - ------- <br /> Final <br /> - by. -. --------------------------- <br /> -- --------------------- - e ------ �� -------- <br /> - ------- <br /> Final fns ection b Date -----/7/ _ __ <br /> SN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Re <br />