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FOR bFP'r'VE'U5E: <br /> ..APPLICATION FOR SANITATION PERMIT <br /> 'P4§rmit No. ----- --------- <br /> - --------- ---------------------------------------------- <br /> (C6rnoete in Tripfigate) <br /> ----------11----------- --------------------------------- <br /> ------------------------------------------;---------------- This Permit Expires I Year From Date Issued Do e Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construtt and install the work herein <br /> described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. <br /> JOB ADDRESS/LOC AaTION -------FR 0 N-1 A 6- ---CENSUS TRACT --------` <br /> Owner's Nagne ---------------------- -------------------Phone,_---------------------------------- <br /> V ------------ '----------------------------------- <br /> r___ _12 ----------I------------------------------------------------- city ----f <br /> Address ----rc q <br /> Contractor's Name ----------------------------,-------.License -------------- Phone ------------------------------ <br /> Installation will serve. Residence E]Apartment House-E] Commercial railer <br /> er Court 0 :7 <br /> Motel F-l Other -------------------------------------i <br /> Number of living units: ---------- Number of bedroom s ---------Garbage Grinder --—-------Lot Size --------------------------------------- - <br /> : r` <br /> Water <br /> -----------:------ ------------------------ <br /> Water Supply: Public System and name ---------------------------------•------------------------------------------------ = ------:Private fi <br /> C) <br /> Character of soil to a depth of 3 feet. Sand'E] Silt o Clay F <br /> Peat E] Sandy Loam ,, -Clay Loam E] <br /> Hardpan E] Adobe E] Fill Material ------------ If yes,type -----I------------------------ <br /> jP1.0t plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sicle.j_�_ <br /> ,,_�,/INEW INSTALLATION: (No septic tank or seep permitted if public sewer is available within 200 feet,) <br /> Liquid DepthPACKAGE TREATMENT SEPTIC TANK';�� Size-/72--- ...... P" -S---------------- <br /> Capacity Type PRVXM _I _ Material-0.0,N' No. 'Compartments <br /> istance to nearest: Well ...... ---------------Foundat'ion --- Prop. Line <br /> LEACHING LINE of Lines ......2-- ----------- Length of each line----- ---------- Total'kLength ----- <br /> ----------- <br /> 'D' Box/-s-----.,p Type Filter Material ---RO_!��K__Depth Filter Material ------- ...... <br /> Distance to nearest: Well ---- Foundation --- Property Line ---------------------- <br /> i,E] No ell <br /> SEEPAGE PIT Depth .............. Diameter-, _t_f------------ Number ---------------------------- Rock-Filled, -YeSr <br /> Water Table Depth -------- ....... ----------------------Rock Size ---------------- ------ <br /> C �-_ 11 N. . <br /> 1__�4 - - i__O.�Prop. Line ------------ <br /> Distance to nearest.. Will- ------- ---- ----- ------I----- ...Foljnd�tiori----------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit;O ------------------------- ------------ ----- Da 1---------------------------------- X, <br /> Septic Tank (Specify.Requirements) -------------------------------------------------------------- -------------------------- ----------- - <br /> Disposal Field (Specify Requirements) Wo-------13-401-VVk- "__ -04----it-ov ES <br /> -1 -Z__A�, <br /> NO 4F-WA -5 U ------ <br /> _#----PRO, ,> --------OR--------- -------------------- <br /> COND-ITIOW-----OF�___Ukl>,fi__: ------ <br /> - ------------- <br /> -----7---------- ---- --------------------- ---—---------------- <br /> JDraw existing and required addition on reverse side)' <br /> I hereby certify that I have prepared this app1ii_atIo—naWd-tK_a_t_tKwork will be done in accordance'with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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, I shall not employ any person in such manner <br /> as to becoma-4wbl o Workman's Censatlon las o; California." <br /> P, <br /> Signed <br /> ---------------- Owner <br /> - .M- 1 <br /> By ---------------------------- --------- --- -- -- ------ --------------------------------------- <br /> Tile -- -------------------------------------------- ------------------ <br /> (If other than owner) <br /> 7 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------------------- --------------------------- --------- DATE ....7 --------- ---------- <br /> BUILDING PERMIT ISSUED - -------- M. <br /> -- - ---------- ---------------------_-DATE =--- ---------------- <br /> --- ------------------- <br /> __P _.t---- )5.9i-t-------------------------- ------------I---------------- <br /> ADDITIONAL COMMENTS _1e4j_F__WFj___ ---m y <br /> -- ---------------------------------------------------------- ------------ - - ------0- -- ----------------------------- --------------------------------------------------------- ------------ - <br /> ----------------------------------- ----- -------- -------------------- -- ------ I---------- ------------------------------- ---------- <br /> :-------------- ------V------ __11-------------1�---------------------------------------- <br /> Final I-M-sp I :r- <br /> -------------------------------------- Dat <br /> ---------------- e ------ <br /> ----- -- -- - -- -------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />