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= APPLICATION FOR SANITATION PERMIT <br /> .f_................................ ...... �` ' - Permit No �-_ ., <br /> IComplete In Triplicate! <br /> .... This Permit Expires I Year From Date Issued <br /> 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 Is made In eompllanee,with County Ordinance No. 549 and existing Rules and Regulatlonst <br /> JOB ADDRESS/LOCATION ..-.:...--- � - c .. �.... I � .7...�jF�� . .-......... NSUS TRACT <br /> F r ..................... <br /> Owner's Name <br /> ....... . ...........Phon .........✓ ........ <br /> / .-,,A dress ... ...... ............Cty .............. ........................... <br /> f #rector's Name .... ., �. 1.� ......................................License iltc?V5.iM.2 . Phoner . <br /> installation will serve, Residence p Apartment House C1 Commercial OTraller Court 0 <br /> f t <br /> Moel p Other----•--•-•--._._•....-- ...... <br /> - E if .i. <br /> dumber of hvingi units;...__? ... Number of bedrooms ........Garbage Grinder'............ Let Size .x�f�..tr_..��..�..... <br /> Mater Supply: Public System and name ....................................................... ............................................Private' � <br /> Cfiaracter of soil to adepth`of.3 fast: Sand 0.— -Silt Q Gay :Q Peat p• Sandy_Loam 0 ;`Clay.Loam ❑ <br /> t Hardpan Adobe 0 fill Material yes,type <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 pub tc sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] S€z ,..-.5....................... Liquid 'Depth .. .... <br /> I paclty Typej..e Material. No. Compartments <br /> . . <br /> Distance to nearest: Well € <br /> � l .__...��'..............•---•-.--Foundation ..,5�.6...;......... Prop. Lute ...;2.v .........d <br /> .EACHING LINE {t ] No. of Lines ................ Length of each Ilne. �G................. Total Length .�fr�d...... ... <br /> ... <br /> f------Type Filter Material / x`-?yam,.DeptFilter Material .... .................... <br /> t � "D'`Box;-='- '� -h � ........ ' <br /> . Distance`to nearest Well ,-0 `. _...... Foundation : ..................... Property tine . .. <br /> ., .. ...,0 <br /> SEEPAGE PIT t ] Depth' .`" . Diameter . 3..... Number ... `,�................. Rock Filled Yes No... <br /> _..__.�...._ t Water Table Depth _......................................•.....RockkSin ................................ <br /> F Distance to.nearest, Well ... .............................Foundation .................... Prop. Lina ................... <br /> REPAtR DDI F..........�...........................•• -............................... .I <br /> /A TION IPrev. Sanitation Permit� Date <br /> I Septic Tank )Specify Requirements) .................. ..':..:.. ..:...: ...........`...... ................................................._.................o� <br /> 'Disoosal Field ISpecify SRequirements) ...:.......:.'........................................................... ................................................... <br /> . .................... ............ i ................ i ...t....................................I..... .... .......................................................__..__.. <br /> ..... .... . <br /> .. <br /> ...........................•........... .:.:.:......-:_:,...:::.... ..:..............._............_._...:._...................:..........................:....................._......._......... <br /> i t (Draw ixisting and required addition on reverse side) <br /> I Yhereby certify that 1 have prepared this application and that the, work will be done in accordance with Son Joaquin <br /> County Ordinanies, State taws, and Rules`and Regulations of the San Joaquin Local Health District. Home owner or Mon- <br /> z. <br /> sed agents signature certifies the fotlowing: <br /> "I certify that in the perfo once of the work for which this permit Is issued, I shall not employ any person In such manner <br /> as to become sub Oct to ork Cort► n tion laws of California." t <br /> gned . .. -• �.... .............................•-•-•-•---..... Owner <br /> SY ........ ......-._._`. :-:_ �--.:....-...:...` ..t. ...:-..-..... :._._ jitle....................................... ..................... <br /> - _ <br /> Jif other hi. owner) .. , <br /> XIA DEOARTMENT USE ONLY i <br /> APPLICATION.ACCEPTED .B --------._'.. <br /> I .. .... . ....... - .. .. .. ._....... DATE . _r.. . <br /> ...... <br /> ................ . .................... . AT€- .. ..................`...,..:-.. <br /> .!.......BUILDING PERMIT ISSUED ......... .. ....... .. . <br /> ADDITIONAL COMMENTS ....... ........ ................. ............................I...................... <br /> s .................... <br /> --•------------•• .................................................................... .................................................. . <br /> -11-..- ---------------------------------- .........•..................................... .........:...................... <br /> ...-..-.... . . . ...................... <br /> . -•.... .. ................... .......................................... .... ........ <br /> ' final Inspection by: <br /> r ...............Date .. . <br /> EM 13 24 1'68 ljov• JOAQUIN LOCAL HEALTH DISTRICT 5/74 3M <br /> k <br />