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r+• / M1-4 { <br /> FOR OFFICE USE: FOR OFFICE! USE: <br /> APr t SANITATION PERMIT <br /> ete in Triplicate) <br /> V^ <br /> -------------------- ---------- I"�tt® V <br /> ate Issued-t -.S%�� <br /> __________________________ __V._t__- --------------- -- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the'San:J%aquin Local,Nealth�Di-st' for a permit to construct and install the work herein described. <br /> This application is made in compliance with'County Ordinance'No.•549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT ON... ��I (/I ------a�1 -- ---`-----. <br /> yr✓ ---.CENSUS TRACT-------- ! ' <br /> Owner's Name- .rLO, P�"i2.�.c� - - Phone - ��---- ------ <br /> Owner's Z -� <br /> �� -�wJ 7 <br /> Address---- - -- ---- =- ------------�d-} - -- ----•- --- '---.- City - - - - - ----------------- �P------;�- -=- -------•------ <br /> Contractor's Name--A'--Qj d ,.------License # -----Phone <br /> a <br /> -4 <br /> ; <br /> serve: i Residenrtment House. . Commercial ❑ Trailer Court ❑ <br /> Installation will se Apartment <br /> 1 ❑" <br /> �.3 Motel ' Other_. __ _ <br /> Number of livingunits:______-.- Number,.of.•bedrooms------------Garbe - <br /> i /a ' r f ge ender LotfSize <br /> 4 ---------------r --------- ------------------------------------/; <br /> Water Supply. Public System and name ------------------------ ----------- ------> ` " - -'- --- . -- . Private. <br /> Character of soil to a depth of Vef et: ' Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ `• <br /> p , .. ..... : <br /> f :i Hard n E] Adobe El :'Pill Material__-__ ______1..f yes, type--- ___------______________ <br /> - i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings,ietc..must be placed on.reverse side.] <br /> NEW INSTALLATION: " (No se�pt'ic tank or seepage pit permitted ifpubl-ic'sewer is available within 200 feet,) P. <br /> { 1--t-SEPTIC TANK Size_ f {{- r t (� -� f <br /> PAC1.CAGE TREATMENT , $ - - -d__'-- ----•-- -------------------------Liquid Dep#h:-�T---------"--may <br /> I Ca pacity_IA-Oxv__ ype - Material-_-----_�*- ---- No. Compartments______._ ------------------° <br /> 1 1 t4 :i <br /> ^ '� ,Distance:to.nearest: Well--�e�n th of ectc _li_ng- Foundation_- Prop.--Q _ _ Prop. Line_ _____________ <br /> LEACHING LINE',• � No, of Lines. _ g .._ -_ ." C/ r_ ------Total Len t11--------� _ ______________ <br /> D' Box.- --------- a Filter Materia _ ---,----Depth FilterE.Material__'__-______ 1 __ _ ____ _ <br /> € <br /> r .Distance to nearest: Well -.� - i Foundation-_ D____ :._..Property`Line ___ <br /> SEEPAGE PIT Depthr_z-- ___-Diameter -r�S i`--Number : ------------ _;r aj i `Rock Fillet! Yes No'.[:] <br /> t . a - <br /> Water Table'Depth ��-- --`- - -A -- Founockt gize l ne r— '. <br /> �� <br /> Distance to nearest:'Well."l./-�_----- .----- ------- --- Foundation. ;= -----.Prop. Li <br /> REPAIR/ADDITION (Prev. Sanitation Permit# 'lt ______________ -------- :_` ---.Date --- <br /> . == --------------------- -'- y -------- <br /> Septic Tank (Specify Requirements}_.,—:---- ---..k3__ l-- - - - --------- ------------- ---}- <br /> ----- ---- <br /> ----------------------- <br /> Disposal <br /> , <br /> -i <br /> Disposal ------------------------ <br /> i <br /> Field (Specify Requirements)______________________ ___--_a-. <br /> _ = - <br /> -- ---------------•---------------------------- - - - - - ----- ---- --- ------- ---------- <br /> - --max` ¢- i . <br /> " {Draw existing and �equi�red addition on reverse side}_ ,s <br /> I hereby certify thafA-ha" a p d -this application and,ifiat.theR-work will be done-in accordance with San Joaquin County: <br /> e <br /> Ord inances,"S to 'l.w,\and Rules and Regulations-of•the-Sa� aquin Local Health District. Home owner or licensed agents <br /> signature certifies the following: <br /> "I certify that in the perforni6nce of'.the workfcr;yAi6 this permit is issued, it shall noF employ any pero,in such manner as r <br /> to become subject to orkman's C opnpensation--lawsiof California." <br /> Signed--- u_GC -9d►nea=-- <br /> By --------------- ------- ---- ----------------- - - -- elf ��, itle --- ` ' ,�, --- 1 Y <br /> - <br /> (If other than�o 6, <br /> ''� } , <br /> I <br /> FOR-DEPART <br /> MENT USE ONLY I;ii tr. <br /> APPLICATION ACCEPTED BY-.--- ---- - - ---------------- --------------------------------------------------------- �--,---DATE._ —_ '�" f ` <br /> DIVISION OF LAND NUMBER- ------ ------ - - = '\ `--.DATE-=---------------- = k <br /> ADDITIONAL COMMENTS-_. - " ---- ------------------ �k ------------ <br /> ------ ---------- <br /> ----- ----------------------------------------- ----- -- --' ---- --------------- <br /> c ����" <br /> --------------•------"-----------•------;------------ -- --- -- -- ------------------------------------ -------------------------- __ --- ---- <br /> ------------------------------•---------- <br /> Final Inspection rby.-'-- - ---------- - " - ------Date.-- --`� y� - ----- <br /> EH 13 24 JOAQUlN LOCAL HEALTH DISTRICT-- 's� F&521677 REV. 7/75 3M <br />