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FOR OFFICE USE: t <br /> APPLICATION FOR 'SANITATION PERMIT Permit No: <br /> ------ <br /> - -- ------ - ----------------------- ------------------ (Complete in Triplicate) <br /> -------------------- Date issued------ <br /> This Permit Expires 1 Year From Date issued <br /> --------- ----------------------------------------------- <br /> ( <br /> Application is hereby made to the San Joaquin Local/i Health Co County tri dine"n for e pe <br /> Local t and existing Reconstruct and install he work ons <br /> described. This application is made in complt, e � <br /> m...-- -- - -- - <br /> S'Q_. Petr_ick="Aar ----------- CENSUS'TRACT�� = <br /> JOB ADDRESS/LOCATION . -- <br /> Phone ------------------------------------ <br /> Owner's Name Mrr--B-Qgex------ - ----------- <br /> Same --------'------------------------- --- City Stkn-r-------- :---- --- <br /> Address -- <br /> - .i 1 i <br /> r <br /> ---.License # --2t'Z$���- ----- Phone _.�G-��-_�C- - ----•-- <br /> Contractor's Name _--B]2+ ka�'2'�-s _Spt --:TYI- -------_--------- ---- <br /> 4 <br /> Installation will serve: ResidenceJE] Apartment House'( Commercial :❑Trailer Court i❑ y <br /> r lmotel 1' Other --------------------------------- -------- <br /> 4__Acre-------------------- <br /> _--_ .___ Lot Size __�� <br /> Number of living units:_._-.---- Number of boom ----� -----Garbage Grinder .__ <br /> --------Pn <br /> vate:] <br /> - - <br /> 1 i <br /> -------------------------- <br /> Wat�r Supply: Public System and name --------- <br /> i <br /> 1 Peat Sandy Loam El Clay Loam:❑ <br /> Character of soil to a depth of 3 feet: Sand:0 Silt❑ Clay ❑ E] <br /> F t Fill Material ---- if Yes,type ----------- `-------------- <br /> Hardpan ❑ Adobe ® _ ,�� <br /> t;uildi}n,gs, etc. must be placed on reverse side.] <br /> (Plot plan, showing size of lot, location of system in relation to- wells, 4 l # <br /> 4., 1 N <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is.available within 200 feet,] <br /> F Size - ; ---- -Liquid Depth ----------------Y---ti---- <br /> I PACKAGE TREATMENT [ I SEPTIC TANK-[ ] <br /> 4 - Na. Com artments ------------•------- <br /> Ca acit - Type --------------------- <br /> tMaterial- p <br />• P Y <br /> Distance ito nearest: Well --- ---- =----- Foundation --------------- Prop. Line ----------...-----•• <br /> I LEACHING LINE [ No. of Lines -------1-------------- Length of each line------ -40----------- Total Length .--- -0---•------- <br /> �� Depth Filter Material _____ ---- g ------------------------ <br /> -D' <br /> -------:------•- <br /> 'D' Box i_ --__ Type Filter Material � 2____----• 1P 2,�+ L <br /> f t + " F,oundatian_ 1- 1 ----------Property Line ------- ....... <br /> Distance to nearest':Weli -------=-��-Q_I-:-` - . No ❑ <br /> i1 +X8-+ ; -------------- Rock Filled Yes <br /> EJ f �xV�1Z �] Depth __�- -10�-- �i�iarmeter ---- --------- - Number ----- --- --- <br /> ,�--�— ° .> : Rock Size ------2"-------------•------- <br /> 5ta.m Water Table Depth e -=-- 9C- ---------------- <br /> P <br /> Distance;to-nearest: Web-----_140-°_------ ------Foundation -------- �-1- Prop. Line --.._2Q..-------=• <br /> n �, '.I Date ----------------------------------] <br /> t REPAIR/ADDITION(Prev. Saniia�yytion Permit# ---- ---------------------------- - <br /> i1 F. <br /> --------------------------.,------------------- <br /> Se <br /> ------------------._- --_. <br /> Septic Tank (Specify Requirrnfis) -------------------- , <br /> Disposal Field (Specify Requirements) Zl4-;=-- - each-- g <br /> ------------• -- --- <br /> ------- �j'-- ----------'---- --'-------- ---------- <br /> {i i` <br /> �. - t----------------------- <br /> -------- - -- ------ - - -'----------------------------- <br /> ---------- <br /> ---------------------------- <br /> ------------------------ <br /> --------------------- - --- -- <br /> ---�- - (Draw existing and required addition on reverse side] <br /> Y ' <br /> I her certify that 1 have prepared this appination and that the work will be done in accordance with San Joaquin <br /> , IRules and`Regulations of the San, Joaquin Local Health strict, Home owner or licen <br /> County Ordinances, StatelLaws - <br /> sed agents signature certifies the following: t :1 <br /> V f <br /> "I certify that in the performance_ofTthe work for which tFiis permit is issued, I shall n employ any person in such manner <br /> as to.become subject to Workman's Compensation laws of California." � t <br /> -----• Owner <br /> Sign- Title - - ------- - --- - ------------ <br /> h SY �-�J----- ------ <br /> (If other than owner) <br /> f FOR DEPARTMENT USE ONLY <br /> APPLI.CATION ACCEPTED BY _. - <br /> ------------------------------------------ <br /> ----- DATE __10-� �_ -v�----------] <br /> -BUILDING_._P:ERMIT-ISSUED._-- ----- --------------------------------------------------------------- <br /> - -_ -_: r :_DATE_ =T=__ . <br /> ADDITIONAL COMMENTS ----------- <br /> -------------------- <br /> ----------------- ----- ------------------------------ - - - <br /> --- --------- <br /> ------------- ---- - <br /> - ,7 - <br /> --------------------- <br /> Date - <br /> _ _ ____ ------------------------- <br /> Final Inspection b ------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F H 9 1-'68 Rev. 5M __ <br />