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FOR OFFICE USE: <br /> ` = APPLICATION FOR SANIT�iiION PI*RM1T Perini# No. _.. !__`__ -- <br /> f_ <br /> (Complete m Triplicate) <br /> -------------- This Permit Expires 1 Year From Date Issued Date Issue r <br /> Application is hereby made to the San Joaquin Local Health District for pe�rriit to construct and install thei work herein <br /> described. This application..is..,made in compliance with.County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATI N .-- ------ "'6V�_ - --------------- —' :----------CENSUS TRACT -—-_:-[. -�-^-- i <br /> Owner's Nam ------------------/.. ------- ----------- ----- --- <br /> -)~ - <br /> Address X------ J E t --- ---- 41- City- �- i <br /> r <br /> Contractors Name ____©11 6414 1fj <br /> • -`------------ -----------------------------------------License # ---------:--'----------- Phone ------------------------------ <br /> Installation <br /> --•--------•-•------Installation will serve: Residence *Apartment.House,E] Commercial ❑Trailer Court ;❑ <br /> ! Motef� Other ---- � --------------------------- <br /> Number of living units__ _________ Number of:Bedrooms -_t--_-Garbage Grinder --,- Lot Size`___-A-C-REA -----__---.- s <br /> 11 <br /> Water Supply: Public System and name -------- -------------•---------- ----- -----------------------------------------{--�--------------------Private <br /> ° - -- t <br /> -Chdracter of soil to a depth of 3,feet: Sand'❑ Silt E] ' Clay ❑' 4Pe6t•❑ _Sandy Loam ❑ Clay Loam:, <br /> Hardpan ��dobe '❑ FillMaterial _A/i -__ ifyes,1 <br /> {Plot plan, showing size of lot, location, of system in relation to wells, buildings, etc. mustt beplaced on reverse side.}. } .l <br /> NEW INSTALLATIO14:--� `(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I �" <br /> PACKAGE TREATMENT <br /> k � [ I SEPTIC TANK [ l Size _ - ---- ------------------ -- ----t�- Liquid Depth ----;--==-------'---.-----. . <br /> Capacity -------------------- Type -------------------- Material---------------------- ,Nbs Compartments E--------------...... L, <br /> - Pro `Line --------------- <br /> € <br /> ♦♦♦ Distance to nearest: Well ---------------- ---- - ---_--, p. ----__-_-- ___--- � <br /> ----•-__----..Foundation ------ -- - - --._J' <br /> LEACHING LINT: [ ] No. of Lines ------ gline <br /> g f ______ J <br /> Length of each line______�� ��=� otal-•Len th --____�___ � <br /> ------------.----•--.Depth Tilter Material -- ---- --;- f ------ <br /> -A <br /> ---- - <br /> 'D' Box _---___ Type Fitter Material <br /> Distance to nearest: Well ________________________ Foundation------------------------- Prope tyrr Lin ?--'_____________._._____ <br /> . <br /> Std&P,AGE iPIT—[­} --Dep#h— ------- ----- Diameter=--------------- Number ----- -- _.�__.h--�_ ._._iZock�Filled Yeses Na 0 � <br /> Water Table Depth -------------------=----------------Rock Size ---------------- --�---- ' <br /> x I <br /> nearest: Well _-____________________________________Foundation ___________'!_______ Prop. Line . <br /> s �...__ <br /> 1 --------------••---- ---- --------} r <br /> I ry <br /> REPApR ADDITIOp(Prev. Sanitation Permit Date• . V • <br /> ------ - ----- - -- -- ------ ---- --- <br /> Se tic Tank (Specify Requirements) ----- ---- ---------- - --------------------------- ------- ---•- ^ <br /> Disposal Field (Specify Requirements) ---- t 5: -------- `� '�� ---------------- <br /> --------------------------------------- <br /> -------------- <br /> - _ . <br /> --------------------------------- --1E_aQ14&M-------- ------------ ---fix -- --------- --------- - -------- ------ a <br />-.o. _ _ _ — _ <br /> hereb cerci that I have re ared this a ging -- ---re -- --------------------------------------------------eid <br /> ----------------------- -- --------- -- ---------- - - <br /> _ - ------ - ----- ----�--•-- and required addition on reverse side) e <br /> IDraw existing <br /> y certify p p p� tion and that the work will be done in cicaTrdance with, Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner. or [icon-. "F <br /> sed agents sibnature certifies the following: <br /> "I certify thai in the performance of the work for which this permit is issued, i shall not employ any person Wsuch manner <br /> as to become jubject to Workm 's Compe so ion laws of California." 7 <br /> Signed . ' -----' - - ----- - ----- caner <br /> By ------------------ ------- Title --- -------- ---- ------- - ------------- - -- - - -A-------- <br /> ------- -- --- <br /> (If other than o ne <br /> IFOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPT D BY ----- _ ___ t_R 10}'--- - �1-�� - - ----- - -----. <br /> ri __—__r ,� —t+J .fE -- <br /> -------------- <br /> ;_`' BUILDING—PER1U11T"IS UED�""�'- <br /> �` � rADDITIONAL COMME T5 ------� rU1 -1`� ' +,''; �' a � 1��-� <br /> Q �flP� <br /> 1 _ ----------- <br /> ----------67-1 --- <br /> - t <br /> ------------ ---` • • <br /> r I <br /> t _ _ _____ ___,_-__ __ ___ - __ _________ _ __ _ ------------------------ <br /> _ __________--_- _ ----------------------------------------- <br /> Final Ins pec -- - ------ ------------ Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ,- <br /> E. H. .9�,, 1-'68 Rev. 5M ;, <br />