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-- /�S✓ <br /> FOR OFFICE USE=S APPLICATION FOR SANITATION PERMIT <br /> Permit No. --.7 --- <br /> -------------- (Complete in Txiplicats) <br /> ---------- ---- = Dat <br /> --- ---=------- ------------- <br /> -------------------- <br /> e issued <br /> ---` This Permit Expires 1 Year From Date Issue <br /> struct and <br /> the work herein <br /> licat;on is hereby made to the San Joaquin Local Health <br /> lth DiCounttrice for a permitrmit t and ex con sting Rulestalnd Regulations- <br /> App <br /> egulat ons- <br />' App lication is made in compliance with <br /> described. This app 15— 5�:)--- <br /> CENSUS TRACT <br /> I. JOB ADDRESS/LOCATION --------�Z � ------- =l � - .- . . <br /> y <br /> Phone -4 � " <br /> l Owner's Name ---- '--- -=- -dhA� . ��-----•---------- -------- -- --� }`��_ <br /> - ----------- Cit Fo-" "------------ --e--� -- <br /> Address '--------- -s- P_ 3 Phone <br /> ' Name --k-- - _:►:�t�-'a� �� --�-- ----- -------- ----- ------ ---License # � .- - '� <br /> Contractors <br /> Residence ®Apartment-House,0 Commercial ❑Trailer Court <br /> Installation will serve:::- ' <br /> Motel El other ->------------------------------------------ _ ----- <br /> Number of living units----,-j------ Number of be ; ------ <br /> Garbage Grinder -_--------- <br /> Lot Size. l -- <br /> Private <br /> Pub1;c System and name <br /> -------------------------------------------------------- <br /> ------- ----- ------ ---- <br /> ----------------------------- - . <br /> Water Supply: Y Peat ❑ Sandy Loam,X' Clay Loom.0 <br /> Y <br /> t Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ - <br /> e -------------- <br /> system <br /> ---------- v- <br /> • � Hardpan ❑ - Adobe'❑ Fill Material -�.-.---- if yes, typ_„_ <br /> of s stem 'n relation..to' wells, buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, locationY sewer is available within 200 feet,) <br /> NEW INSTALLATION: (No septic tank or seep e p p ------------- <br /> �t pe -- Liquid Depth ---,�- / <br /> Size--_ <br /> PACKAGE TREATMENT ( ] SEP71C TANK' ?_ <br /> --,-- No. Compartments ---- :----•-------- <br /> ��� TYPe r�� ' Material---------------- „ <br /> apoclty .- -'- 6 10-------_---- <br /> J -------------Foundation J,--------------- Prop. Line _ - - J <br /> - Distance to nearest: <br /> Well ---�� �"�- ------- pen <br /> LEACHING LINE No. of Lines _ -- <br /> _-__---_--- Length of each line---V �°"� Total Length p --= <br /> 4/De th Filter Material -_-- ---� <br /> 'D' Box -_.---- Type Filter Material - - '' p <br /> 4 -__- Property Line_ _ ----------•----- <br /> Foundation ------------------- <br /> Distance.to nearest: Well ----------------- -- ' <br /> �.d...:.. v 4'. Rock Filled Yes ❑ No <br /> r-- ---------------- Number oc---- ---- ------ <br /> ' SEEPAGE PIT' [,) .. ,'•....'Depth y------------- ----- Diameter <br /> .. :. Water-Sable Depth ------ ----=--- - <br /> -Rock Size <br /> �..;��.... Pro Line --•------ <br /> . : : ? Foundation ---------------= P . <br /> ---------------=------- -------- <br /> ,Distance to,nearest: Well __---.-- ) <br /> % Ya t i : <br /> • -----�:--- Date --------------•-- - - ------- <br /> - - ---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------- --- - - - <br /> q .., ... . ...... <br /> Septic Tank (Specif Requirements -- a <br /> Disposa! Field (Specify Requirements- ----------•-- <br /> ----------------------------- <br /> ----------------------------- <br /> ------------- <br /> ----------------- <br /> k A <br /> 4JA - --- ---------------------------------------.- <br /> ia --- ---------- ---------- <br /> f f. <br /> _ � .•- (Draw existing and required addition on reverserysie <br /> occor <br /> 1 hereby certify that I have prepared this application and thh the San Joaquin the work will e i one int . District. ce e`tone or I cen- <br /> County Ordinances, State Laws, ,;and Rules and Regulations <br /> of sed agents signature certifies the following: person in such manner <br /> ' "I certify that in4he performance of the work for which this permit is issued, I shall not employ any <br /> as to become subject 'Wor man's o pensation laws of California." <br /> � Owner <br /> Signed . <br /> - ------- <br /> Wa <br /> - <br /> ---- --------- -- Title -------------------------------- -------------- <br /> ;(If other than owner) <br /> Z "t. FOR DEPARTMENT USE ONLY <br /> ' DATE --- <br /> APPL1CATION- ACCEPTED BY ---- -T�= -- , --------------------- <br /> - <br /> -- <br /> -: ----------e-_,_--;�.Pil;e�::k".dst ,Ai.e-:--- ,..,. .- a °� - - <br /> BUILDING PERMIT ISSUED - r ---------------- <br /> ADDITIONA0tOMMENTS _._------- =---------------- ------------------------------- -----:----- <br /> -------- <br /> ------------------------------------------ -------------------- ------- <br /> ---------------- ---- <br /> ----------- <br /> ----------- -- --- -- - <br /> A ------ ------ <br /> ---- ' Date ------------------------ <br /> --------------- <br /> - - <br /> Final lnspecti ---- -SA N JOAQUIN LOCAL HEALTH r H DISTRICT <br /> r E. H. 9. 1-'68 Rev. 5M _ ' <br />