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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> 0 --- -------- <br /> ----------------- ---- --- ------- ------- <br /> (Complete in Triplicate) <br /> -------�?,----------- - Date Issued ---/0-ni-14.1 <br /> V _N�\--f his Permit Expires 1 Year From Date Issued <br /> ----------- ---------- <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to const ruct ctn install the work herein <br /> described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> -------------------------- <br /> CENSUS TRACT <br /> JOB ADDRESS/LOC/ ON/Oil - ----- - ------- <br /> Owner's Name ... A ------- -------------Phone <br /> ------------- <br /> Address --------------------------- - ----------- City -- ------ ------- -------'----------------•---- <br /> # ------ Phone <br /> Contractor's Name ----------- -- - ----- ----- - -- - ------ ------ -_License <br /> Installation will serve., Residence.'rk Apartment House,F­l Commercial :E]Trailer Court 0 <br /> MotelF]Other -------------------------------------------- <br /> Number of living units:..__ ---- Number,of �bedrooms ----_.Gcirbcige Grinder ----------.. Lot'. Size --------------------------------------- <br /> Water Supply. Public System and I name -------- i-----------------•--------------------------------k-------------- ------------------ --------Private EJ <br /> Character of soi I to a depth of 3 feet. Sall 'Silt Clay ,El_1 F Peat❑ Sandy Loom -E] Clay Loam E] <br /> pn Adobe Hard - <br /> 'a El rcl If yes,type ---------------------------- <br /> (Plot plan, sh'8%;ing 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 /> SEPTIC TANK I I - Size------56.('_��--- ---------V <br /> PACKAGE TREATM <br /> ENT __ Liquid Depth -------------------------- <br /> U <br /> Capacity:- <br /> Q----- Type C Compartments <br /> It 4 Distance to nearest: Well -------------—---------------Foundation .... --------- Prop. Line -------------- <br /> n <br /> rr!�!4................ <br /> LEACHING LINE No. of Lines --------I---------Y�-31_engthsof each line ---- ---- Total Length <br /> ---------------- <br /> 'D' Box ------------ Type Filter M Material --- --------------- <br /> -.2teria. ner-k7.Depth Pilter <br /> -- 0—- <br /> Distance to ne&est:,WetI ----------------- ndation -------f.------.._-..._ Property Line _.rte 7 <br /> kA - e No 0 <br /> \'-.SEEPAGE ♦ <br /> PIT lDep�th—___4/7" Diame ......4 --- <br /> t&—____—----- Number --- ----------- Rock Filled Yes` <br /> Water Table Depth --------------------------------------- I...Rock Size -------------------------------- Ir <br /> Distance to nearest. Well ---------------------------------.......Foundation ----26P......... Prop. Line --------------------_ <br /> Ji— V I Date I i-------------- <br /> REPAIR/ADDITION-(Prev. Sanitation Pell ---------------- - --- ------------ ------ - -- <br /> a-A <br /> ...VRA <br /> J-Qxceu* <br /> Septic Tank {Specify R—equirements) ---------- <br /> Disposal 'Field (Specify Requirements)—_71� -----deu - ------------------------------------------------- <br /> ----------- <br /> - -------------------J------------------------------------------------------ <br /> -------------------------- ------------------------- --------------------------------------- <br /> ----------------------------------------------- ---------------------------------- <br /> ------------------------- -- -- ---------------------- ------ ------ ---------t_�---------------------- <br /> ([�ra—w­existing alhd_rpq�uiil addition on(-reverse side) ww <br /> 1 hereby certify that I have prepared this applil'c—aflon,and that the--work�will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of ihii-Son-Jo* licen- <br /> sed <br /> Health District. Home owner or III <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 become subject to Workman's Compensation laws of California." <br /> Signed ----------- ---- ------------- ----------- ------ --------------• Owner JL <br /> By ------ (i"i-64-erhan ned --------------------- -Title ..........qr-.;s 717-------- _�---------------------- ------------------ <br /> FOR DEPARTMENT USE ONLY <br /> / '2.4 7/ <br /> APPLICATION ACCEPTED BY --------l_0__EAkV&'k- ------------------------------------------------------------------- J DATE - -" -- -------------- <br /> BUILDINGPERMIT ISSUED -----------------------------------------------------------------------------------------------------------DATE -------- ---------------------------------- <br /> ADDITIONALCOMMENTS -------------------------------------------------------------------------------------------- -------------- --------- --- <br /> --------------------------- <br /> - <br /> --------- ------------------------------------------------- ----------------------------------------------------------------i------- ---------- <br /> ------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- --- <br /> -------------------------------- ---------- ---------------------------------------------------------- <br /> Final Inspection by: - ---------- --------------- to <br /> I " ------------ <br /> Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />