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11 0R­O <br /> FFICE USE: A <br /> APPLICATION FOR SANITATION PERMIT <br /> .......... .................. ...................... �21C <br /> Permit No— ................ <br /> (Complete In Triplicate) <br /> 6 <br /> Doti Issued,/................. <br /> ........................................ This Permit Expires I Year From Date Issuid <br /> Application is hereby made to thit 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. 549and existing Rules and Regulations. <br /> JOB ADDRESS/I.00ATION ::...... CENSUS TRACT ........... <br /> ....... ... <br /> Owner's Name ........ . . .................................... ...........Fbane ...... .................. <br /> Address ---- 7' city <br /> ...............0_0� .K�F,67............ ............•. .-_:---------------•---•---•-----.-..-..-•............-•---- <br /> Contractor's Name 4A A .0 ns.-- ,e ce e*��.'. Phone lf._Qzn4 �__ <br /> _ <br /> Installation will serve:fij Aptj Resident A" Apartment House 0 CommercialOTraller Court 0 <br /> Motel []Other ...... .................... <br /> Number of living units:.../..... Number of bedrooms Garbage Grinder Lot Size ......... <br /> Water Supply: Public System and name .............................................................I.................. ------ Private 0 <br /> Character of soil to a depth of 3 feet: Sand E] Silt 0 Clay 0 Peat 0 Sandy Loom 0 Clay Loam 0 <br /> Hardpan 0 Adobe 0 Fill Material ............ If yes,type.......... <br /> (Plot plan, showing size of lot,,location of system" In relation to wells, buildings, ate. must be placed on reverse side.) <br /> I <br /> NEW INSTALLATION-- (No septi?c tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I Size---_-- ..................... Liquid Depth .................... <br /> CapacityI.................... Type ........ ...... Material..--....... No.', fitments ...................... <br /> Distancelto nearest: Well -..:_.-.-•••... ........... ...... . -rop. Line ......................of <br /> LEACHING L No. of Lines ........................ Length of each line---- .................... Total''Length ._-_.------_------------_--.10 <br /> V Box .1........... Type filter Material ............... .....Depth filter Material <br /> Distance to nearest: Well ......................... Foundation ........................ Property Line .......................... <br /> SEEPAGE PIT j Depth .................... Diameter ......... ....... Number ............................ Rack Filled Yes 0- No 0 <br /> -Water' Table Depth ------------------­- ............ ..Rock Size ........... ........ <br /> Distance to nearest: Well ........I.. ....... Prop. Line .... <br /> ....................................foundation ................4 <br /> R-EPAIR/ADDITION jPrev. Sanitation Perm' ifi'# ___-:!...... .................... ...................................• <br /> 'Septic Tank (Specify Requi�ements) .?. . . ....... ------------- <br /> 01 <br /> ............ <br /> Disposal Field (Specify RequIlre mints) <br /> � V <br /> -----------------------r:,...................................... <br /> . ........ ........ ............................... .......................................... ................... <br /> ............................ <br /> -----------------------.................................. <br /> -----------*................................................ <br /> .............. --------- -------- <br /> raw existing n required addition on reverse side) <br /> I hereby certify 4hat I have`jfrepared this ai�;iikatlon and that the work will be done In accordance with Son Joaquin <br /> Counl�- Ordinances, State taws, 6d1`46 and kbgulations of the San Joaquin Local Hecil&Dlstrict. Home owner or,lican- <br /> sed cigenttoInI <br /> sioiiiature certlhes�!fie following: <br /> 11 cirtity"' e perl`orm'a�ce'of the work for'which this permit Is Issued, I shall not employ any person In such manner <br /> . hat . <br /> as tcbbicime sublect to Workin an's Compensation laws of California." <br /> .1 <br /> S i 4 01-"."....... i " <br /> -­­ ------------------ -- -------- . ...... ........... _ Owner <br /> ------- --- <br /> ....... Title <br /> - -- -- . . .......................... <br /> -- --------- - <br /> (if other than owner) <br /> / R DEPARTMENT USE ONLY <br /> 1F0 <br /> APPLICATION-_ACCEPTED BY 12 <br /> ------------------------- DATE�_/e_ _? _/ <br /> ----------------- <br /> BUILDING PERMIT 'ISSUED -----------------------------DATE ----------- ....... ....................... <br /> ADDITIONAL"COMMENTS .,.'.".-..,.'-!' <br /> ----------------------------------- --------------------------------------------------------­­­.. .... ......... <br /> ------------- ------------- ........................ ............................................ .....................­........................................... <br /> ---­----­------------- --------------- ........ <br /> � ------------------------------------ I--- ---•--------------------------- - ------------------------------------------------------------------------------------------------ <br /> -- <br /> ----------------------------------------- <br /> tL � nAnspedtion by. - Date- -- <br /> ------------------- <br /> EH iY 2 1-68 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 8/7h 3M <br />