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FOR OFFICE USE. <br /> t. . V_, APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No: <br /> Date Issued _-/,/- 0 <br /> ------------ ---------- ------------------------------ <br /> This Permit Expires 1 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 /> described. This application is'made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> '' CENSUSTACT T�,7--- <br /> JOB ADDRESS/LOCATION _____ ______ _ (� r ) <br /> OwnersName ------------ --------- --- -- -- - --------------- •---------- e I <br /> Address ss -------- ----------�_-_06 �- t <br /> 1-------. City ---------/ ------�---1-------------- ••-•-- <br /> Cont actor's Name - - -_---- License-6i! f------ Phone .'T_�Jlz 7_!? 7 <br /> Installation will serve: Residence Apartment House[] Commercial"❑T a ler Court <br /> Motel'[?Other -------------------------------------------- <br /> Number of living units:----- Number of bedrooms `` ---Gar age Gri der _ +_, . Lot Size __��x-__ ----------- <br /> Water Supply. Public System and name . _ ------_ _ �.-_'____ _______f PrivkA ❑ <br /> -'-— ,-- -----��--- --`- - --------------�.._---- <br /> PP Y� Y _______ <br /> Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay ❑O4Peat❑• Scndy-Loam-❑ Clay Loam.❑ <br /> Hardpan E] Adobe Fill Materiai ------------ If yes,=type ---------------------------- <br /> (plot <br /> .tplan, <br /> _.._________(Plot,tplan, showing size of lot, location of system in relation to wells, buildings, etc. us°t be placed on reverse side.) i <br /> NEWINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available,within 200 feet,I <br /> PACKAGE TREATMENT <br /> { ] SEPTIC TANK f ] Size---------------------------------------.!--_i Liquid Depth -------------------------- <br /> i, T Q <br /> Capacity -------------------- Type -------------------- Material----- ---------------- No. Compartments ---------- <br /> � s <br /> Distance to nearest: Well ------------------------------------Foundation -------,_------------- Prop. Line ------------------------- <br /> LEACHING LINE [ ] NDo.B z Lines l----- - -- Filter I'Length of each line---------------------------- Total Length ------------ ..... .. <br /> TypeMaterial --------------------Depth Filter Material- -------------------- ---------•----------- <br /> 1 <br /> Distance to nearest: Well _____ __________________ Foundation -------_--_--_._______ Property Line ___--_---_---_-_- -... ' <br /> SEEPAGE P!T [ i] Ddpth ---_------------'Diameter --------------- t----------------------- Rock Filled Yes ❑ No 0 <br /> . Number ___ <br /> Water Table Depth )_ _------------------------------..Ro�� Size ------------- <br /> e <br /> Distance to nearest: Well -------------------------------------- Foundation --------------- ..._ Prop. Line -_------------.------ ' <br /> Sek tic Tank ti _ Date ----------------------------- <br /> Septic <br /> ---------------------------- 1 , <br /> p (Specify Requirements) --------------------- ----- <br /> REPAfR ADDITION{Pw.Requirements) <br /> Permit,#,.,�--., ---------------------- - -------- ------------- --'---------- <br /> Di posal'Field (Specify Requirements) ------- - - ...- __..__. <br /> waf��T / ---- <br /> i �. <br /> - -_ � - l� - i --------------------- <br /> Draw existin and required addition on reverse side <br /> I hereby certify that.[ have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rulestand,Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies-the-following:— _ <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as tolbecome subject to Workman's Compensation laws of California." <br /> Signed -------------------- ------------------- -------- X_ _1. <br /> "' ,------------------- Owner <br /> BY --------- - r -c <br /> (If of er tha o ned <br /> ----C ti,., Title -- 4----------- ---------- ------- <br /> --------------- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- --- - ---- ---- - --------------------------------- ------------------------------. DATE ------ <br /> BUILDING PERMIT ISSUED ------- --------------------------------------------- -- - --•--------------DATE -- --- ----- --ADDITIONAL ----------------------- -- <br /> ADDITIONAL COMMENTS = - <br /> A <br /> ------------------------------------------------------------------------- --------------- <br /> ---------- -------'--------------- <br /> ------------------------------- <br /> ----------------------------- - - - ---- <br /> - �_- - <br /> Date� ---- ------� - <br /> Final Inspection b N JOA LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M �� <br />