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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No: .`- <br /> 4& <br /> (Complete in Triplicate) <br /> ------------------ ---------- --- -- ------ ------ Date Issued e�oO:7�lrt <br /> � 7. --------I This Permit Expires I Year From Date Issued <br /> ----------------- ----4------ <br /> herein <br /> App.lication is hereby made to the San Joaquin'Local Health District for a permit to construct and install the work <br /> described. This applicotion'is�made in complian_ce�(With County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LC ---------- ---------CENSUS TRACT -------------- ------ <br /> -------- Ao ------- ---------------------- 7 P <br /> ,L4 � s - 1 07 1 _7? <br /> &TiC;�-'j ­-------------------Phone I--------------_--- <br /> ' �A ---- ---C�41 <br /> rZ -A------ ----------- <br /> Owner's Name J. <br /> Address ---4-Ve.1 <br /> ----------i----------- City-f-------------------------------- ------------------------------------------ <br /> _�icerise # 17-7-r <br /> Contractor's Name -----C��--------I------ ---------------------------------------- Phone <br /> Installation will serve: Residence 13'*Apartment House-D Commercial 0Trailer Court [3 <br /> iMotel 1Ot� r ----- I--- I <br /> 0----------------------------------- <br /> Number.,ofLhving.units <br /> Number,of,bedroom s---,-S-----Garbage 'Grinder ---- Lot Size ---Ik------ -2. -2 -------- <br /> Water Supply. Public System and name ------------- z---------- ----------------------1---------Private Er--' <br /> Character of soil to a depth of 3 feet. Sand'E] SiltO Clay [D Peat [j] Sandy Loam.-F] Clay-Loom 0 <br /> (A <br /> Hardpan El Adobe [pe*lill Material -- --------- If yes, type - -------------------------- <br /> JPIot plan, showing size of lot, location of system in relation to wells, builciings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted"if.,I public ;sewer it available within 200 feet) %,1, 4. k_j� : --------- Liquid Depth <br /> -SEPTIC-TANK "Size:::.—--------- -0 - - X <br /> PACKAGE TREATMENT -------------_-- <br /> Ir <br /> P600% Tv-pe"I 6 4' Akt 'Material_ ' �16ANo. Compartments _'.011-------- <br /> Capacity -A- - - I L_ �#__ <br /> 11 .01 0 <br /> 'Distance to neares�Weljl ----- ---------------------Foundation ------------- Prop. Line :'�%-- ------ <br /> LEACHING LINE [0-r' No. of Lines __'_A---------- -Length of each line---7�----6------s-_____'_------- T6tcil Length J-410------ ......... <br /> At <br /> D' Box _VC--T Typ6j <br /> Filter Material -----------Depth Filter Material 111----------------------------- <br /> Distance to nearest: Well ---IV_ --'I---------- --Foundation !4 ------ ----------- Property Line _s?_.___-_-___._.:..- <br /> ---------- Yes 4 <br /> SEEPAGE PIT [s,}- Depth -------- Diameter ------ Nuniber Rock Filled No <br /> Water Table Depth _ts�--------------------------- ------------Rock Size A'a---------- -------- <br /> I . - 4 il �r p. Line S� <br /> ./-F�'7 ation _�g,(2---------.-- Pro -------I............ <br /> Distance.to.nearest. Well 10-P.--------------­--------- und <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ----- J Dof� --------------------•------------- <br /> - <br /> Septic Tank (Specify Requirements) --------------------------------- <br /> -------11��--------------------------------------- --------------------------------- <br /> ----------- _1> I <br /> Disposal Field (Specify Requirements) ----------------------------------- -I- ---------------------------------- -------------------------------------------------------------- <br /> ----------------------------------------------------- <br /> ----------------------------------------------------------------------------------- <br /> ----------------------------------------------------------- <br /> ---`--•----------------- ---------------------- ----------------------- --------------------------------------------- ------------------------------------------------------------------------I---------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I h6ve prepared this application, and that the Work will be done-in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of *6 Sari 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 to becom s Irct q Workman's Compensation laws of California." _31 <br /> Signed ------------- ---- Owner <br /> B ------------------------- Title -------- -------------------------------- ----------------------------- <br /> y <br /> r i <br /> (If other than ow r) <br /> X FOR,P;P5gTMENT USE ONLY <br /> *'7 <br /> ------------ -------- <br /> -------------------------- DATE ---- <br /> APPLICATION ACCEPTED BY -----------/5V14__ - ------------------------ i--------DATE ------ --------------------- -------------- <br /> BUILbING PERMIT ISSUED ------------------------ <br /> M TS -- ----- <br /> DITIQNAL CO _;F_4�401.0 <br /> Or-------------------------------------------------- -------- <br /> AD S <br /> I ----- -- --- <br /> ---------- ----lv_o <br /> ---------- ----- <br /> ---- ------------------------------------------------------------------- <br /> ----- ---------------------- ---------------------------------------------------------------------=------- <br /> P <br /> ---I------- <br /> Final Inspection b <br /> eze—------------------------------------------------------------------ ----------Date --------- <br /> y- --------- ------------------------------------ --------------------------------------- <br /> -SAN.JOAQUI N-LOCAL-H EALTH-DmI.STRICT-_�_ <br /> E. H. 9 1-'68 Rev. 5M <br />