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'- s <br /> a <br /> OFFICE USE: APPLICATION FOR SANITATION PERMIT �a "1a73 <br /> Permit No.::FOR <br /> --------------------------------------- -- (Complete in Triplicate) <br /> ----- , <br /> Date Issued _//._�--7'� <br /> x This Permit Expires 1 Year From Date issued - <br /> -- . ---- , <br /> `. <br /> Application is hereby made to the San <br /> n compliancelc with County tOrdnan a No. 5A9 and existing Rules rmit to construct and talnd hRegulat Regulations <br /> described. This application pis..made <br /> JOB ADDRESS/LOCATION ._ -03_ ------ h�I�cv- CENSUS TRACT'- ------ <br /> s - <br /> Owner's Name ' -_.- -- - <br /> ne <br /> ----� cit ---- ---- --� � - <br /> �° fir- �-��-5�--- y ----------- -- <br /> /� _ _ <br /> Address -_ - •- <br /> �..�'-� Phone <br /> W. <br /> Contractor's Name --_--•----- i "�� <br /> License <br /> Installation will serve: _ Residence [Apartment House[] Commercial MTrailer Court <br /> IMotel ❑Other --------------------------------------- <br /> __ Lot Size --- -----------=- -------II-- -1'-/--,- <br /> Number of living units.-__/------ Numer of bedrooms '�-----GGarbage Grinder b ._ -- -- .- - - <br /> 'Private <br /> Water Supply: Public System and name _________________� __-_ Clay Loam <br /> Cla Peat❑ Sandy Loam [] Y <br /> Character of soil to a depth of 3 feet. Sand O1 ,Sil fl Y ❑ <br /> Hardpan d Adobe 0 Fill Material ____-._____ i es,type <br /> !. W <br /> (Plot plan, showing size of lot, location of syst,�rri in elation to wells, buildings, etc. must be placed on reverse side.} <br /> it ermined if public sew r is avai ble within 200 feet,) <br /> � fi <br /> p seepage P p ii .40 <br /> NEW INSTALLATION. {No septic <br /> TANK'[ F Size_ -'� X•��x� ~------ Liquid Depth ___---=----------------- O <br /> PACKAGE TREATMENT [ ] -------------------- <br /> - _ <br /> `� _ � _F/1� Material.-___+® NoCompartments __ <br /> Ca acit zZU-Q - TY e ._� _ _. _ .._�.-- <br /> p Y c. _ - �� � _ 'Pro Line �-------- <br /> _ —� -- - - Well,,,_,f }•_ "" Foundt�tion_� C �� P .F <br /> Di.stance.to�near :; � e7 <br /> ... .� -� Length of each line__ ------- --------- Total Le n,t r --.`-r <br /> ' No. of Lines �'-I <br /> LEACNINGFLINE [ --__ _ <br /> ��� Type Filte Material _K---•---Depth._Filter_,Materiai ;�_ -�- <br /> ll <br /> 'D' Box .- - -- YP ,. - teei -. � '�'.�" ' <br /> Property Line •-----...__. <br /> Y 1 \ a <br /> Distance to nearest: Well �- ------------- Foundation <br /> Depth Diameter Number ---------------------------- Rock Filled Ye 1 [3 No <br /> E SEEPAGE PsIT [ 1 P r <br /> 1� _Rock Size _-_._-- <br /> Water Table Depth - ----------- -e` ------------------� ------•-----_+_-=-Foundation -____-- <br /> ------ Pra Line!_.\�A <br /> r I Distance to nearest: Well __�__________________ <br /> , ..._ <br /> REPAIRJADDIi ION(Prev. Sanitation Permit# ........--f,""---"- -""--' -."---- -""-"- " <br /> Septic Tank (Specify Requirements) ------------------------------------------------------------ <br /> -------- --- --------------------------------- ------------- <br /> i Disposal geld [Speci# Requirements} 1 -:\ <br /> ----------------------- <br /> �___ 3� <br /> ------ ------- ----------- <br /> -- -- --------------------------------'----------.- e in a f <br /> l� wail be do <br /> --- --- -- -------------------- <br /> z__, -._..---•.-(-Draw•existing and required addition on reverse side) <br /> a 4 .� ., � j. u ardance with San Joaquin <br /> 1 hereby c�tify thal-have epw� tF�is application and that the work <br /> County Ordinances, State Laws;and Rules and Regulations of the San Joaquin Local Health D strict. Home owner or licen- <br /> sed agents signature certifies the following. P person in such manner <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employe! P .y - <br /> ` as to be a subjec W rtrCman's Compensation laws of California." <br /> Owner <br /> Signe ----- ------ -- <br /> -- ---------------------------------- Title -- <br /> BY ----- -- - -- ---------=--- <br /> (fother Phan owner) <br /> FOR DEPARTMENT USE ONLY <br /> ?- DATE - J72,.------------------ <br /> APPLICATION ACCEPTED BY ----------------------------------------------------------- <br /> -------------- ------ - DATE <br /> - --------------------------------------------- - -------------------- <br /> BUILDING PERMIT ISSUED ----------------------- ---------- ----------- ---------------- <br /> ADDITIONAL COMMENTS ------------------------------------------------------------------------- <br /> ------------ <br /> -------- - ------ <br /> -------------------------------------------------------------------------------------------------------------------- <br /> ----------- <br /> Date ------- <br /> Final Inspection by: ------------------------------------ ----------------------------------------------- <br /> ---------- -- <br /> .LOCAL HE _ <br /> ------ - DISTRICT <br /> -SAN-JOAQUIN <br /> c u 0 1_'68 Rev. 5M <br />