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1 <br /> FOR OFFICE`USE: <br /> APPLICATION FOR SANITATION PERMIT ------------------� <br /> --------------------------------------------------------- Permit No. --- <br /> �� t j (Complete in Triplicate) <br /> Date Issued <br /> ----------------------------------------- --------------. This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> JOB ADDRESS/LOCATION ---------LD-11-71 Y -- � 4�Qr\+-__CENSUS TRACT -----&-................ <br /> Owner's Name ----ae-1_/2i1_1 � G� t�C <br /> �---------ii - : --------------------------------� Phone ---------------------------------- <br /> -- <br /> CityAddress -- - v°- - ----- ------ <br /> ---LicenseContractor's Name ---- e <br /> Phone -r ` __S �Ca <br /> Installation will serve: Residence IV Apartment House❑ Commercial ❑Trailer Court i❑ <br /> Motel ❑Other --------------------------------------------- <br /> Number of living units:--- ------ Number of bedrooms -_��---Garbage Grinder ------------ Lot Size - __cam ice:_-----_ <br /> Water Supply: Public System and name -------------------------------------------------------------------•------------------------------------------Private ❑ <br /> Character of soil to a d tth of 3 feet: Sand'❑ Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 10!� <br /> Hardpan C] Adobe,❑Fill Material-Nv��es, type --------------------------- - - <br /> .� ...�_...__ ii <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' <br /> NEW INSTALLATION: (No septic tank or seepage pit fpermit ed`Cs if1%lid-sewer is av ilable within 200 feet,) <br /> PACKAGE TREATMENT [ SEPTIC TANK-[ ] Size---/ 'r� L �_----- .- wompartments, <br /> pth _-� �'"`_----.___ <br /> E few---Capacity ��Q�._ -__ Type-._Fe_�±-- Material�Q-4vC.-'- - -�No._ -���....... <br /> Distance to nearest: Well _---��--�________-_�- -____Fouadation;_pj�l--------__ Prop in .. .-------------- <br /> LEA <br /> ....:........ <br /> [ ] �-: g 7Q- Total L. th � _� <br /> LEACi-IING LINE No. of Lines _____-__ � __-___ Length of each line__.-__- --_------ 'Q <br /> ly e Filter Material <br /> --- --- ----- -0epfh"`F ift t• Material ---- ------ --•----• -----.---- <br /> Distance to nearest: Well ------ Foundation ------/_O---------- Property Line -sr------------------- <br /> SEEPAGE PIT ] Depth ------------ ------- Diameter ---------------- Number ---------------- ----------- Rock Filled Yes ❑ No .[3 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------- <br /> Distance to nearest: Well -----------------------------•----------Foundation -------------------- N.F. Line....................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _-------__---_-----___-_______-_--)� <br /> t �. - -.\_ <br /> Septic Tank�(Specify Requirements) ---------------------- <br /> Disposal Field (Specify Requirements) <br /> l t TPa E3.-- LZSF- Wfri�--.6miibm-------__It , <br /> 11 <br /> tori!- - -� <br /> ---" - <br /> -'t------ '` N- ---�01A------- 4 u��y o------HA—RD-PAM-- <br /> A1A -------- ----------------------- <br /> ----------- ------ ---- / Q----- � rM - . z- , � ------------------------------------I ------- ---------------- <br /> (Draw existing and required addition on reverse side} i <br /> I he Lby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances State,La s,Nand Rules and Regulations of the. San Joaquin Local Health District! Home owner or licen- <br /> sed agents signature Artifies the following: <br /> "I certify 1h tin the performance of the work for which this permit.is issued, I shall not employ an ,person �i such manner <br /> "a's4a, eco sub ect to Wi rkman's Compensation laws of California." c+_ <br /> Sned '.! f r' / r f `� f------------------------------------- Owners! <br /> BY ------ - --------------------------------✓-------- --------------------------- Title ------------------- <br /> S7.2 1i <br /> (if other than owner) <br /> FOR -DEPARTMENT USE ONLY <br /> -------------'<1 1''1�ij------Vii,==���"--�!`.{E..............�DE#7E��' �-'��-.�1 <br /> APPLICATION ACCEPTED BY ___"7`,} I <br /> BUILD'ING-PER'MIT"ISSUED--------- - _._..._---- - _ <br /> �T.__.,DATE--------------------------------------------- <br /> ADDITIONAL <br /> ----~:--.-,__:_- <br /> - -----------------------------------------------------------------=----- ----- ------------------ <br /> ADDITIONALCOMMENTS -- ---- ------ ---------------------------------------------- ------------------------------------- ------ ----------------- ---- --------------------- ---- <br /> ------------ --------------------- - - ------ ----------------- ----------------------- <br /> Final Ins ectio - --1 �-------------------------------- ------------- -Date <br /> - = C ==_ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />