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OFFICE USE: <br /> APPLICATION-FOR SANITATION PERMIT <br /> :0-1, ---- ---- 7 <br /> ss Permit No.. - <br /> .4 (Complete in Triplicate) <br /> ---------- ----------------------- <br /> Date Issued <br /> This Permit Expires 1 Yecir;jl`rorn Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District,ifor a permit to construct and install the work herein <br /> described. This applicatio"In is,made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION I .--_-_17---------------e!WR,&y7JR----R,0_-------- ____ -..CENSUS TRACT -------------------------- <br /> Owner's Name ----C— "0 <br /> 6,6t ,V11 � 4 <br /> .,4 <br /> --------------- --------------`------------------------------------..__Phone <br /> i. <br /> Address ---- A -----------/I&A-114-1-----------------------------------------I it------ city ---- ------------------------------------------- <br /> Contractor's Name °! <br /> .__-__-.License--------License #/7_,?60SV--- Phoney its <br /> ---------------- <br /> Installation will serve: Residence+*Apartment House,E] Commercial -❑Trailer,Court ',E] <br /> Motel E].Other%------------ --------- ------------------- <br /> Number of living units:- Y------ Number of bedrooms -- - _____Garbage Grinder Lot Size -----S71-1 -------- <br /> Water Supply: Public System and name --------------------------------------------- -----------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand[-] Silt E] Clay E].:� Peat E] Sandy Loam Ej Clay Locim .E] <br /> Hardpan F <br /> 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.) (.4 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if, ublic sewer is available within 200 feet,) <br /> ir /I i 4 <br /> 10, <br /> PACKAGE TREATMENT SEPTIC TANK Size--I-i'y--------e-S_ ------------------- Liquid Depth ------------------- <br /> Capacity loW-49 Type//@.*,,,4 M teria~o(907" No. Compartments IR------------ <br /> . 71, <br /> !I: 0�1 I <br /> Distance to nearest: Well _-3-7-0------------- --------Foundation _40-11------------ Prop. Line <br /> LEACHING LINE ` <br /> o. of Lines __._-/_________________----------------- Length of each line___AW__`___________._ Total Length 14V <br /> V Box _IVO Type Filter Material ----- 4 <br /> Filter Material ---/1_1V 1_1____----------------- <br /> Distance to nearest: Well ---------- Fo ------- ............. <br /> rdation --- --- -- Property Line <br /> SEEPAGE PIT Depth ----R.5--e <br /> ---- Diameter ----- Number --------1-------------'---------------- Rock Filled Yes � No 0 <br /> Water Table Depth ---- - ---------------------1.:--------Rock Size ----------- <br /> il I <br /> Dli.stance to nearest: Well --ZO-49---------------------------Foundation _/a------------ Prop. Line ----------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------- ) <br /> :11 .11. <br /> SepticTank (Specify Requirements) ------------------------------------------------ --------------------------------- ----------------------------­--------------------------- <br /> 11. 11Disposal Field (Specify Requirements) ------------------ !! --------------- <br /> -------------------------------------- ------------------------------------------------------------------------ ---------------:-------------------I------------------------------------------------------- <br /> ------------------------------- ---- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I hI e prepared this application and that the' work will be done in accordance with San Joaquin <br /> County Ordinances, Sta4,,Lows, and Rules and Regulations of the San Joaquin'lTaccil 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 't <br /> permit issued, I shall no employ any person in such manner <br /> /D Workman's Co <br /> as to become subject t Workman's Compensation laws of California." <br /> Signed ----------------- - -------- I$ <br /> 1--- -------------- --------------------------------------- Owner <br /> By ------------ ------ - - ---------- <br /> th ? - - --- ----------------------------------------- Title ----------------------------- ---- ------------ ------------------------ <br /> o 0 1. <br /> ther 0 ner <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED! BY ------------P10------- --------------------------------------11----------------------- ---------- DATE 7z"--------- --- <br /> BUILDING PERMITASSUE� ---- -------DATE ------------------------------------------- <br /> ADDITIONAL COM At. <br /> ///?,X'2 x------------------------- --------------- <br /> MENTS:' 't <br /> ------------------------------- <br /> --------- - -------- <br /> ----------------------------------------- ------------------- ---------------------- ------------------------------ ------------------------------------------------------------------------------------- <br /> ---------------------------------- ---------------------------------------- --------------------------t----------- <br /> - -------- ------_------------ <br /> Final Inspection by.. ---------------------------------------------------- .4 <br /> --------------------------------- -------------------Date ------------ <br /> II <br /> SAN JOAQUIN LOCAL HEALTH 'DISTRICT <br /> E. H. 9 1-'6$ Rev. 51 <br />