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FOR OFFICE USE: <br /> APPLICATION FOPermit No: 7yz <br /> R,SANITATION PERMIT <br /> ----- ------------------ - ------------------------- " <br /> (Complete in Triplicate) <br /> -------- ------------------- --------------------------- <br /> Date Issued <br /> ----------- --------__------------____.____-_-_______- This Permit Expires 1 Year From 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 existingRules and Regulations: <br /> — — — ------CENSUS TRACT -------------------------- <br /> ------------------- <br /> ---------------------- <br /> JOB ADDRESS/LOCATION''"_"' _�:�--� ----- -----------=---- ------ --- <br /> Owner's Namef�L? _ � ss <br /> ------Phone ------------------------------------ r <br /> Cit r�-� <br /> Address ---------------------------------- <br /> , <br /> ------ - -----------�°_ i �IZ2KLA Y r <br /> � PhoneContractor's Name License # <br /> --- <br /> Installation will serve: _lZesidenc6 i partment House,❑:Commercial :❑Trailer Court .';❑ <br /> Motel ❑Other -r--------- i ------------------------ / <br /> e Number of livingunits------------- Number of bedrooms-- _:µ..G Garbage Grinder ------------ Lot Size _.__-.I /__--------------____-- <br /> Water Supply: Public System and name -------------- ----------_ - ----- ------------------------------ - ----------------------------_Private <br /> Character of soil to a depth of 3 feet} Saricl �, ,0 <br /> rSilt- —1;Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ 1 <br /> F )Hardpan ❑ Adobe ❑; FilI Material ------------ If yes,type _________________________ <br /> ' � k <br /> ! 1 <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 seepape pit permitted if public sewer is available within 200 feet,) <br /> ,,.-_ i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f `aSiie�--------------------- <br /> Capacity <br /> _____________________ Liquid Depth ______-__.__.--------_---. <br /> p Y --- -- YP <br /> k� 1 Caacit �� _ Type ------------ -----`Material-------=------------ 1�o. Compartments ---------------------- � <br /> I o, k <br /> Distance to nearest. Well _- ___-__ ______________________Foundation _4P______________ Prop. Line-z_._.___ tfI <br /> a _j <br /> LEACHING LINE [�No. of Lines _____;?7=:-------- <br /> 'D' <br /> Length of each line.._7�--- _____________ Total Length __f_*z_'_C�--------_.---- <br /> 'D' Box -e ------ Type Filter Mate riaQ1_-_�Depth Filter Material -------- _______________________ <br /> Distance to nearest: Well ____ ____________ Foundation ___ -------------- <br /> Property Line. fl!?"...`.................... <br /> SEEPAGE PIT [ } Depth ------I------------- Diameter -------- ------- Number _.-------------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth -------- ----------------------------•-f------Rock Size -------------------------------- <br /> I <br /> Distance to nearest: Well -------------------------------I---------Foundation --------------------. Prop. Line -------------------_ P <br /> t <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- Date ----------------------------------} <br /> SepticTank (Specify Requirements) ---- --------------------------------------=------------------------------------------------------------------•------------------------ <br /> DisposalField {Specify }Requirements) ------------ ----------------------------------------- -------------------------------------------------------------- --------------- <br /> . ------------------------ ----------------------------------------------------------- <br /> :--------------- --- E - <br /> RI(Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 Healih District. Home owner or licen- <br /> sed agents signature certifies the following: ` <br /> "I certify that in the performance of t e work for which this permit is issued, I shell not employ any person in such manner <br /> as to becom subject to rkman' mpensation lows of California." <br /> - ------------------------/------------------------ Owner <br /> Signed-- -`�'----- - --------- - / , <br /> By ------ -- --- -------------- i ------------------------------------- Tlfle -------- -- ------------------------ <br /> -- - ------- - -------------- -- <br /> (If other than owner) <br /> ,FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- --- - ----------f - ------------•--------------------------------------- DATE _.__ d5 23----------- <br /> BUILDINGPERMIT ISSUED ------------'--=----- 1-------- ------------ ----------------------------------------=----------_-DATE ---- --------------------------------- <br /> ADDITIONALCOMMENTS�------------ ----------- -----------------------=---------------------------------------------------------------------------------------------------------- <br /> t r 1 <br /> --------------------------------------------------------------------------------------------------- <br /> 5 -------- -------------- --------- --- ------------------------------------------------------------------------------------------- ------ <br /> t� <br /> _--------------------------------------------__-_-_____ !��C.______----- _ - _-____ <br /> Final Inspection by: ____ ___f <br /> Date ------- --------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i E. H. 9 1-'68 Rev. 5M <br />