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FOR OFFICE USE: " APPLICATION FOIA SANITATION PERMIT <br /> ----------------------------------------------- <br /> (Complete in Triplicat?,) Permit No: <br /> Z-------------------------- <br /> Date 'Issued ---�"L3_- . <br /> ---------------------------------------- This Permit Expires 1 Year From Date Issued . <br /> -4(74 W�-t s I F' Al «'e. <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 compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB <br /> ADDRESS/LOCATION ., ��^ --- 1-- try-- � ----.CENSUS TRACT --- -- ---- -- <br /> 'Name ' ----------------- <br /> - -----------------. , <br /> f if ------------------- <br /> Phone '/. <br /> -�---------- <br /> Address - city <br /> - <br /> Contractor s home -� �� �C --- - License #Z0- .-- <br /> Installation will serve: Residence M--)�partment House,❑i.;mmercidl []Trailer Court ;❑ <br /> Motel ❑Other -- ----- , <br /> Number of living units:---/------ Number of bedrooms -----Garbage Grinder �fQ-_. Lot Size _._ -----�'-- ------------------------- <br /> L Water Supply: Public System and name --. ' - -_ Private [ <br /> Character of soil to a depth of 3 feet: Sand,❑ Silt ❑ Clay ❑ Peat ElSan. y_loaT,7.. �Ciay Loam 1�-` <br /> Hardpari❑ Adobe'❑ Fill Material ------------ If yes,type --------------------------- <br /> (PI'ot-,plan,-showing siie,'of l6t,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,) (n <br /> i PACKAGE TREATMENT J I SEPTIC TAMC:[ <br /> Size-?--"-X T: -���°-- Liquid Depth __ - _---__.. <br /> O.,f.__-- T e .- --- �'-t Material-�_ -Z No. Compartments '.......-- („ <br /> Capacity!-� yp <br /> 4 <br /> Distance to;�nearesf<1 611, ._-_-, ------- --------------Foundation 149- Prop. Line ------ ---------------- <br /> ; <br /> s o <br /> LEACHING LINE No. of Lines 's _'.=r-:"� -''Length of each line-_19 -._____---- Tota! Length 1 ---------------- <br /> D' Box------------- -Type Filter Material j6 C�.---__-Depth Filter Material -I- --------- ........ <br /> ..,� <br /> !, F r , w- <br /> . t Distance-to-nearestrti Well-;------:d-�--�---� Foundation -.�------------------ Property Line --- <br /> e <br /> SEEPAGE PIT [ ] Depth -------- +Diameter ---------------- Number ------------------------- -. Rock filled Yes 'Q NO <br /> Water Table Depth ---------------------------- <br /> ------------------Rock Size -------------------------------- <br /> -- <br /> + Distance to nearest: Well ----------------------------------------Foundation ---------.---------- Prop. Line ---------------------- <br /> F , <br /> REPAIR/ADDITION(Prev.i Sanitation Permit#' ------------ ----- --------------- Da ------_-----------•= <br /> Septic Tank-(Specify Requirements) -, : '-�<- - --- Y ----"- --�. � -----�-�-----��--- <br /> ------ ------ <br /> i --- --- � c <br /> ------ ------------------------------------------------------------------------------ -------- <br /> l -=---------------------------- ----------------------- -------------------------------------- <br /> ----- ------------------- ----------------------------------------------- <br /> + i {Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that thLi"work will-be.dene in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heinith District:Home owner o� licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issuedr I shall not employ any person in such manner <br /> } laws of California." <br /> as to become subject to Workman's Compensation <br /> Signed -- - --- - <br /> -_ wne <br /> t --------------------- Title _. --s L- `'71�{ <br /> BY ' <br /> dif other than owner, <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----T- -:-------------------------------------------------------------------------- - DATE -------cam `f-1-9 ------- <br /> BUILDING-PERMIT-ISSUED..-----_-~- _x_-^------------ --------- <br /> ------------ <br /> ADDITIONAL COMMENTS .-- r ,.. -------- =------`w ------------------------------------------------ <br /> -------------- <br /> --------------------------------------- - -•-- ----- <br /> ---- -- - ----•--- --------- -- <br /> --- - --------------- -- -- --------- ---------------- -------------------------------------w----- = �- <br /> -�-- -------------=-- <br /> -------------- --------------------- - -- ------- -- ------------•------------------------------------------------ - ----. ate --- 67 Final Lnspectio <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />