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4 <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No, <br /> -,w-,--z-�---.(Complete in Triplicate)' <br /> ----- -------------------- ---------------------------- Date Issued -- ----------- <br /> t. <br /> This Permit Expires 1 Year From Date Issued <br /> -- -------------------------------------:----------- <br /> Application is hereby made to the Son 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 ADDRESS/LOCATION ------- ------------_SCA-- --LOA/--CENSUS TRACT ----- ----------- <br /> -------------------Phone-------------------------------------- <br /> Owner's Name --------077-V--------- —----------------------------------- <br /> F-1 ./-IV 0 ---------------- city ----------------------------j <br /> Address ------:X(P-5-7-a------ V�/ -1-117--------------- FS CA LOA ---------------------------------------------- <br /> - ----- -------------------License # -------- ------------ Phone ------------------------------ <br /> Contractor's Name -- ---- vu-,-\I.E�p—------- ---------------- <br /> - <br /> Installation will serve: Re0clE partment House Commercial E]Trailer Court ij] <br /> Motel E]Other ------------------- ------------------- <br /> ------- <br /> ----I-i I -% rind ' Lot Size --------------- <br /> Number of-living-units:----.)-:�-Number-of bedrooms __73------Garbage" Grinder. <br /> -------Private <br /> S ----`--------------------- ------------------------------------ <br /> Water Supply: Public' yst(,m-at? me --- -------------- ----------------- ------- <br /> Chara'cter of soil to a depth of 3 feet. SaAd'E] Silt 0 Clay In Peat E]fv Sandy Loam AET""Clay Loam.7] <br /> Ado e' Fil�7&-�-If ye'-s, <br /> rMaterial)�M- type ---------------------------- <br /> I t , i' ildings, etc. must be placed on reverse side.) <br /> oe'llsbuildings,(Plot plan, showing size oflaf-, 16ccition Or systeminin reijn./T <br /> NEW INSTALLATION: (No septic tank o s11e'6p?-ci g 6! ' 'pit no i tte;d if publiczsewer is available within 200 feet,) <br /> PACKAGE.TREATMENT M- E-�Nl SEPTIC TANK I Size:------------------------ -------------- Liquid Depth --------------------------------- <br /> --------- No. Compartments ---------------------- 'All <br /> Capacity -------- ------- Type --------------------- Material------ - -------- <br /> I - "IX. �y ---------------------- Prop, Line r------------------ <br /> Distance to nearest.I,Well-- ------Found4tidin <br /> line--------------F-t---,------ Total Length ----------I---------------- <br /> LEACHING LINE No. of Lines ----------------- Length of each' ------------ W, <br /> ---- <br /> .'D' Box ------ <br /> Distance to nearest: Well -Filter Material --------------------Depth Filter Material ---------------------------------------• <br /> ty ------------------------ <br /> ----------------------- Foundation -------------- ProperLine <br /> ` Yes ❑ No (3 <br /> SEEPAGE PIT Depth ------- ------------ Diameter ---------------- NU'mber ----------------- Rock Filled <br /> Water Table Depth ---------------------------------------i------Rock Size':--�----- -----------I------ <br /> Well p <br /> Distance to nearest, W 11 ------r---------------------------------Foundation' --i----------- ---- Pro Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# •-------------------------- ---------- --- Date --------------- ____-.--------------1 <br /> Pyr- <br /> Septic Tank (Specify Requirements) ----------- <br /> -- ---------- --------- -- ------------ <br /> I t 4/ <br /> .,.Vl__ - .... <br /> Disposal Field (Specify Require&5) <br /> j-------------------- <br /> --------------------------r---------------------------------- -------------------- <br /> - <br /> k <br /> k- <br /> ------------ ----- <br /> ---- -- - ------ ----- - ----- ---- ---- -- l -------------11 <br /> UNraw'(Draw --d-eZFr�ddcifib -ne�dr- il / ,) <br /> I hereby certify that I have prepdrPd -------------------------- <br /> - <br /> this application and that the work will be in accordance with San Joaquin <br /> ',. <br /> County Ordinances, State-Laws, and Rules and Regulations of the San Joaquin Loca4l Health District. Homdowner or licen- <br /> sed agents signature certifigs like fo <br /> 11cer <br /> I certify that in the performance of the work for which this permit is issued, I shall'-not employ any person in such manner <br /> . O <br /> as to become subjectW k Compensation laws of California." r; <br /> Owner <br /> Signed dw�------ <br /> ----------- .. .................... --- <br /> By - --------------------------------------------------- ------------------------------------------------- Title ----- <br /> (If other than owner) FOR .DEPARTMENT. USE ONLY <br /> APPLICATIONACCEPTED BY -----T-,-B--O------------------------------------------------------------------------------ DATE ......... ----------- <br /> BU I LD I NG-PERMIT-ISSU E D ---------------------- `P_`'--------- <br /> - ----------- --------------- ------ <br /> ----------- -------------- <br /> ADDITIONAL COMMENTS ------------- ---------- <br /> ---•- ------------------------------------------------------- ------------ <br /> ---- ----------------- --- ----- ------ - ---------------------7 ------ <br /> -------------------------------------- <br /> ---------------- ------------ ------------ <br /> 7:---------------------- ------------------------ - ----- ------- - ---------------------------------------------------------------- <br /> ------------ <br /> --------------------------------- -------- ----- --- ------------------------------------------------- ------------------------ <br /> Date ...... <br /> Final Inspe=. <br /> SAN JOAQUIN-LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />