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z FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> —)-� ���-----/r.-r,:....o�..Jj_l -- Permit No-. 7_L--tot. - <br /> U/ (Complete in Triplicate) <br /> This Permit Expires I Year From Date Issued Date Issued .%�//7-/ <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 Co ty Ordinance No. 549 and existing Rules and Regulations: <br /> /� <br /> I JOB ADDRESS/LOCATION -----16 .. l/.._ - 11 !lti/ �!- �LAC� --CENSUS TRACT ........................_ <br /> Owner's Name --- ./'Y. ......... .CcrL-.J�............1.,.................- --.... _- - Ph ne <br /> At --- <br /> ------------ <br /> :� _.._. ._...... <br /> ............._.........---- <br /> .-``.i----' <br /> Address -...-..-_... ..1---� . . �-.' - . ... � ._ .-..------`-............ ................_._. <br /> Contractor's Name .-.-f_ ' ----------- -------..... License # <br /> I <br /> Installation will serve: Residence E]Apartment House❑ Co m�e;c q p,I trCoouurt 0 <br /> Motel ❑ Other ...i- -------------­- .......... <br /> Number of living units:.----------- Number.of �edrrro/o'msj--,..y-Garbage Grinder ............ LotSize/e.0 4 G' - <br /> Water Supply: Public System and name ..{"�-----t------LUN: n...--- . . . ........................--------------------Private ❑ <br /> Character of soil to a depth of 3 feet: Sand I-] SiltE] - <br /> Clay ❑ Sandy Loam ❑ Clay Loam.[] <br /> j Hardpan❑ Adobe❑ Fill Material -._- --- if yes,type__---------.------------- <br /> i (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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK <br /> - � .Saze--y � !•!.--------- .. ------ Liquid Depth <br /> Ca acitY1ao0 - rNo. Compartments�..%:Tytler'wfz r............,........... <br /> Distance to nearest: Well -�.._:___—r------ ----.--__-`-found �- <br /> ation __-_ 0_�.-_.-_ Prop. Line'. ..:........._- ' <br /> • LEACHING LINE 91 No. of Lines _---- --------- Length of eadi-_line..... .0.. .... ...... Total Length . <br /> / t /J <br /> 'D' Sox pr.Q---- Type Filter Material�Ls_' '�-.r- ......Depth Filler Material ...) p..>7. ............................_.. <br /> Distance to nearest: Well .c..._- -----t--founclation Property Line S:_L................ <br /> C ... Rock Filled Yes o L❑ <br /> SEEPAGE PIT [ Depth ..-a�_-_--.- Diameter 3 ..F..: Number"':....J.'.:r._.. f7--'if <br /> fWater Table Depth ..........Rock"Size ....... � <br /> Distance to nearest: Well . ............ f-----------------Foundation __-/---' ''--- Prop. Line ------------- <br /> t ; <br /> REPAIR/ADDITION(Prev. Sanitation Permit+ ...................... Date ----------------.---------------- <br /> -) <br /> : Septic Tank (Specify Requirements) ...------- ...................... .... ...............-................ ,....[..---....,f::.---------------------.-.._.....---- <br /> i Disposal Field (Specify Requirements) -------------------------------- <br /> -- <br /> i <br /> .........................................----------------------_---- <br /> ----- .. --- <br /> f ' <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have 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 the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: I <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 become subject to Workman's Compensation laws of California." <br /> Signed ..............................-----_ __........ - ------...._..........._ Owneri - <br /> ........ .. <br /> - -(C>` --�± ., dile --.._� .. / <br /> By ..._.._--._..-.....------- ----------- - -- / '�----- ......_....................................... <br /> (If other than ne <br /> R 'DE � TMENT USE ONLY pp <br /> APPLICATION ACCEPTED BY ........ ......- .. - -- -------- - .T------- ...._ ............... DATE ...-Jr,---/-----7/--------- <br /> I BUILDING PERMIT ISSUED ---.- -- -----.... .... ...._. ..... DATE .- ------- <br /> • ADDITIONAL COMMENT - - . ... . . - ..... .... . ........ ... ............I............-.............. _... ---- - ----------- ----------------- <br /> ----- ----- - -- --- ----- ----- .................-_.....__...... - - - ------- - ----------------- ----....- - <br /> --- ----------- - ------- --------- ....._. ................. - - - <br /> i .......... . ................... ......_ - -- - - ------ -- - ----- -- -- ----- -- -------- - _ .... - ._..._ <br /> Final Inspection by: -------- .... _- - -'-- -- ---''``�- - - -.-...------_....._. -----------_._Date ...-- <br /> ANAQUIN LOCAL HEALTH DISTRICT <br /> ` <br /> E. H. 9 1•'68 Rev <br />