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FOR OFFICE USE <br /> APPLICATION MR SANITATION PERMIT <br /> ..............Z ....... ---•-- Permit No. .7..�.:.�.�.�. <br /> (Complete in Triplicate) <br /> ._. ..... ...................................... <br /> F Date Issued .7 7b <br /> .... This Penult Expires t Year From Date Issued ................... <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> describe&This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESSAOCATION ..... T—� <br /> Owner's Name . - - -- - <br /> : . ...................... ................. _....-_ CENSUS TRACT .......................... <br /> .� ...... .. ............ Phone ..% Z`. 6 ? <br /> <kddress ... . -- Q `,-•- ................................City ..... .................. ............................................ <br /> Contractor's Name .... .I "..::.:.... ��.'...................License �' .�....... Phone <br /> !nstallation will servo, Residence t$Apartment House C3 Commercial QTrallw Court 0 <br /> Motel 0 Other <br /> Number of living unitac--_. __._...:Number of bedrooms .._3......&rbaa Grinder............ Lot Size ..__._A .1?2..............` P <br /> Water Supply, Public System and name .......................................................... ._ ----- ------------------------..........Private ❑ �l <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe 0 Fill Material ............ If yes,type ............... ............ <br /> mot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be planed on reverse side <br /> NEW INSTALLATION: (No septic:tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> Si e....:.S .`�S _� ...1.............. Liquid Depth <br /> ��r <br /> PACKAGE TREATMENT [ SEPTIC TANK�C] q P ,,__ <br /> p <br /> P ty - - -H... Type .._ -Ca ori ��. Material... -�--. No. Compartments .......--•---...... �, <br /> Distance -to nearest: Well .�...................=foundation .....��............ Prop. Line <br /> -EACHING LINE , No. of Lines ------ ............ Length of . ch line...._ .T-Sa.......... Total Length ...f.7. .�........ <br /> 'D' Box . Type Filter Material .. ..:D6p;h Filter�Materlal ...........�d�.......... ........ <br /> Distance to nearest: We q ...:....o .Q.r....... Foundation .... �... ' ....... Property Line .. ...f.?F`....... <br /> ..J,�e...... Diameter .... �.`.... Number ... <br /> SEEPAGE PIT Depth �..... ..._. ....... Rock Filled Yes No <br /> » fr <br /> „�Water-.Table�DeM .!..................................................Rock Size .. :.T.. Y)-........... <br /> Distance to nearest: Well •----� .........................Foundation ._..t .. .. Prop. Line .. .r......... <br /> REPAIR/ADDITION IPrev. Sanitation Permit# ..._........................ <br /> . ................ Date ................................ .) <br /> SepticTank (Specify Requirements) ............I...................................... ..................... ..........................._............._................ <br /> Disnosol Fieki (Specify Requirements) `. .-- • <br /> .................................. -•----------------- .............................•................_......................................................................................... <br /> ._. <br /> (Draw existing and required addition on reverse side) . <br /> -I hereby certify that I have prepared thI picati <br /> lon and'that Mrs work ieril# be dons In accordance with Son Joaquin <br /> County Ordinances, Slate Laws, and'Rules"dnd Regulations of the San Joaquin Local Health District. Home ownat_ of licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person in such mannan <br /> as to become subject to Workman's Compensation laws of California" <br /> ': ane, .......-,�,.......,.j,.'... ........ .. ' + ...:.. Owner <br /> r <br /> By .... ........................... . ............................... <br /> i <br /> i <br /> (If other n owner) <br /> - FOR D PARTMENT S ON Y <br /> APPLICATION ACCEPTED BY .... .. ..........................., DATE .... �... .� ...`: <br /> BUILDING PERMIT ISSUED •---•- <br /> .....: ....".::'♦.......:__ _--.. DATE-.:................................•----.... <br /> ADDITIONAL COMMENTS - ; '111K � .... -�' -`' ..Z�r,"' '-,' f?C..... ---------- ---------- ....... <br /> ............. <br /> y . <br /> ............................ . ................. -.-..�JO <br /> ....--.-...--•-_..--.............................-... ...... .Final Inspection by: ................. ......... Date ... ........... <br /> EH 13 2a 1-68 R©v. 5�ISAN AQUIN LOCAL HEALTH DISTR}CT 874 3M <br />