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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -- ------------------- ---------------------------------- N <br /> (Complete in Triplicate) Permit o.. <br /> Date Issued 11_e_1070�1 <br /> ------------ This Permit Expires 1 Year From Date Issued <br /> ------ ------------- ----------:--------- <br /> <_4Applipation is hereby made to the San Joaquin Local Health Districtqor,, a permit to construct and install the work herein <br /> tj <br /> -dbe'sZri$ed. This application is made in compliance with County OrclinaQ No. 549 and ex'I s-'fing Rules and Regulations: <br /> JJOB ADDRESS/LOCATION <br /> I <br /> ----- ------- ---- ----.-CENSUS <br /> - ENSUS TRACTS-S.---------------- _j_ <br /> Owner's Name -----------------------------------; ----- -------Phone/----- ----- <br /> Address ........ ------------- -City xi�,,V----------------------------------- <br /> 37 P.Contractor's Name -7 4-A - <br /> l-------------------------------------------------------- <br /> License #,Z5L2 <br /> I I F . _,6 --- Phone j!I <br /> Installation will serve: Residence (Apartment House E] Commercial OTrailpi Court <br /> Motel [:]Other ------------ <br /> ---------------'-°-- `-------- : E. i <br /> Number <br /> ------------------ <br /> Number of living units.-.-/!I---- Number of bedrooms 4Z-_---Garbage'Grinder Lot Size --- <br /> J <br /> tI o <br /> Water Supply. Public SystemI and name --------------------------------------------------- --------- ----------P------------------------------ ---Private <br /> Character of soil to a depth of 3 feet: Sand'2KSilt 0 Clay E] Pedt E] Sandy'Loam ❑ Clay Loari EJ 3. <br /> t7 r <br /> - ""Horclp66 El - Adobe-,[]-Fill Materia" I---------------If yes;type ------------- <br /> fir <br /> (Plot plan, showing size of-lot, location of system in relation to: wells, i;uildings,'etc. must be placed' on',reverse sid6.) <br /> 7 Frtf'W200 feet) <br /> NEW INSTALLATION: (No septic.tank or seepage pit permitted if-public se r availdli <br /> PACKAGE TREATMENT SEPTIC TANK''{4 Size--------------- --- Liquid Depth ----------- - <br /> dt-7*28Materilarl ----- i-6 1 00 <br /> capacity TypA_ ---------- <br /> wag ---- -- - <br /> '4%4�vo. Compartments --- . ....... Do <br /> Distance to nearest: Well -/Cqx----------------i---Founclationr/;g------------ Prop!Lirke <br /> t 7 <br /> LEACHING LINE No. of Lines ----------------- Length of-eachNN <br /> ------- Total Lengtht ------------ ------------ <br /> F <br /> 'D' Box Type Filter Material -!Depth Fitter Material -/,g <br /> -------------r._:`_-...... <br /> Distance to nearest: Well ---Z------------------ Foundation1; ---------- Property.y-Linel <br /> g. <br /> SEEPAGE PIT Depth ------------- ------ Diameter -----------------Numbgr- ----- ----- kocIC Fill'67d.-jes No <br /> a <br /> W ter T -ble Depth ------------------------------ --- Size ------------ ------------------- <br /> a ------Rock <br /> Si <br /> 11; W- <br /> j. Distance toy nearest. Well ------------- --------------------------Foundation -------------------- Prop. Line .------.....------V__ a <br /> REPAIR/ADDITION(Prev. Sanitation Permit#, --------------------------- <br /> ---------- D at;'r2-��------------------------------- <br /> - <br /> --- --------------------- --- ------------ <br /> R �------------ <br /> ----------- <br /> ----- <br /> (Draw existing and required addition on reverse-side) <br /> I herelty, ertify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County,Ordinances, State La" s, and Rules and Regulations of the Son Joaquin LocallHealth District. Home owner or licen- <br /> sed ajenti signature ceTtifies'the foliow-- ing; <br /> "I ceitij�il.�,that in the perform6rice of the work following:. <br /> which this p6rmit is issued, I shall not employ any person in such manner <br /> as to!we e subject to Wo rl:�ma n's'Com pen satio n�laws of California." <br /> + I ; A, I <br /> Sign-4— 11 1 1 Owner <br /> ----- ----------------------------- <br /> -------- ----- Title -A' `W,4�oe <br /> -Pww-- ------------ <br /> ------------ -------------------- <br /> (If ofher than ow' ned , (�T <br /> it FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---------- -------------- ------- DATE ----- -------------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------- -DATE -------------------------------------------- <br /> ADDITIONAL COMMENTS <br /> -- ---- ------------------------------------------------------------------------------------------------------- <br /> - ------------- --------------------- ---------------- -- ------- ------ -- ------------------------------------------------------------------------------------------------------- <br /> ---------- - ----- -- - ----- ------- - -- ---- ----------- ------------------- ---------------------------- - -------e-------- <br /> -- ----- ---------------------------------------Date ....... <br /> Final 1 7' <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />