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FOR OFFICE USE: F <br /> APPLICATION FOR SANITATION PERMIT _. <br /> _ ,t <br /> (Complete in Triplicate} Permit No: ---7 �5 _______. <br /> ---------------------------------------------------------- <br /> ' -_-_ _� <br /> _________________________________________________________ This Permit Expires ] Year From Date Issued 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 ismade in compliance with CountyOrdinanceNo. 549 and existing Rules and Regulations: <br /> JOB AQDRESS/LOCATION ._-{Cf/-c�--- --- -----; / ------------------------------------CENSUS TRACT ----� <br /> Owner's Name ------- ---------Ce' 4f24--d' -------------------- - - --------Phone -----6_a <br /> fJ <br /> Address --- S- . .......e_j------� . ---- °------- ---------------- City -------'�_ lC ----- ---------------------------------------- <br /> Contractor's Name ------ !�A,44------- 4 _= � --------License # ------------------------ Phone ------ ---------------------- <br /> Installation will serve: ResidencEAATApartment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑ Other -------------------------------------------- <br /> Number <br /> -- ------------------------Number of living units------I------ Number of bedrooms ____Garbage Grinder ------------ Lot Size -------------_-----------------------__'___ <br /> Water Supply: Public System and name ---------------------------------•---------------------------------------------------------------------------•-Private [❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay -:),Peat E] Sandy Loam ❑ Clay Loam, <br /> Ha rdpan ❑- "'Adobe-❑'-Fill' aterial _.__________ If yes,type _________-__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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC TANK:[A IMSize------------------------------------------------ Liquid Depth ------------------------- <br /> Capacity <br /> _------------------ -Capacity -------i----------- Type -------------- aterial--------- ------------ No. Compartments ------•--•------------ <br /> Distance to nearest: Well ____,__________ __ <br /> _ -- ----'---------Fourdation - -- ----------- Prop. Line -------------=-------- <br /> r :,. <br /> LEACHING LINE No.of Lines __ _ Len orea line._______ ------------ <br /> '; �_-rr�'. � - lth <br /> gE 9 �� •------------ <br /> t - �do c,� Total Len <br /> D' Box <br /> �� Type Filter. Materia 'r'°�`.Dapfih Filter Material �-------' <br /> Distance to nearest: Well -------------------------- Foundation ------------------ Property Line ------------------------ <br /> SEEPAGE PIT [ ]' Depth __.j--------- Number `. „•:Rock Filled Yes..❑. No i❑ <br /> .-, <br /> Water Table Depth --- --------------------------------------------Rock Size ---------=------ ------•-------- <br /> Distance to nearest: Well------------------------------------------Foundation -------------------- Prop Line ---------.--.....__.. <br /> � ,� , <br /> --- -. Date - ) <br /> REPAIR/ADDITION(Prey. Sanitation Permit# _____________ ____ <br /> Septic Tank (Specify Requirements) _______________ __ } <br /> Disposal Field (Specify Requirements) -= --� ----6G- ----------------------- ---------- - - ------ ------------•---•.-•--------------------------- <br /> 4fj _________________________ --------- -____---____- --------------------- __________ <br /> R ,�� <br /> --- <br /> (D)rawwexisting and required addition on reverse side), <br /> I hereby certify that I have prepared this application and that the work will he done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certif that in the performance of the work for which this permit is issued,4 shall not employ any person in such manner <br /> as to ecom sublet, to W rkman's pensation Paws of California." i <br /> SignedOwner <br /> -------- --- --- ---- <br /> By - ------------------------- -------------------------------------------------------------------------;Title --------------- ----------- - ------------------------- <br /> (If <br /> - -- <br /> (If other than owner) ( A- <br /> FOR DEPARTMENT USE ONLY �t <br /> APPLICATION ACCEPTED BY � (� �- V%� --------------- ------------ -------------------- DATE -----�7-__--r- �-��-T1----- <br /> BUILDING PERMIT ISSUED ------------------------ --- ---------------- --------------DATE ------------------------------------------- <br /> ---------- -------------------------------- -- <br /> ADDITIONALCOMMENTS ------------- --------------------------------------- ------------- -- ------------------------------- ---- ------------ --••---------------•---------------- <br /> - <br /> ---------------------------------------- ------------------------------------------------- ------------------------------------------------ ------------------------------------------ <br /> --------------------=------------- <br /> Final Inspection by. .� -Date `r _ --- <br /> SAN IQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />