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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 466r7olt4 iffTriplicate) Permit ....... <br /> ........... ThIsTe'rmit Expires 1 Year From Date Issued 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 /> JOB 'ADDRESS/LC5,ATION ------- .................. ------ ...CENSUS TRACT ....... <br /> Owner's Name -----_--__--__........._........ ...............Phone ............. <br /> Address AtZ91-R..... --------------------- ...... City _,C;V4V 'T <br /> Contractor's Name /keS' ...6ropTne.....sum../------- ........ <br /> _-------.:..._....License License # _/7-7970..- Phone�W_ <br /> Instollation,will serve: Residence E] Apartment House 0 Commercial'®Trailer Court 0 <br /> Motel E]Other --- --------...---- .......Number of living units:. Number of bedrooms ........n...Garbage Grinder ............ Lot Size ........... ...... <br /> Water Supply: Public System and name ....... ..._-------- ............. ----------- ......................._------1..................­­Private El <br /> Chorederof soil too depth of 3 feet. SandEl Silt ClayE] PeatL] .�Scmdy.Locimo Clay-Loam.0 <br /> Hardpan 0 Aclobe�a Fill M6terial ............ If yes,type............................ <br /> qv�— <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 permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTICTANKDZ ----- ------ - Liquid .Depth . ...........M-...... <br /> Capacity 1ppaaK Type Material( Compartments ----_--- <br /> Distance to nearest: Well ... .__Foundation ...1.0.............. Prop. Line ....S- '_.:.._.....A <br /> I <br /> LEACHIMAINE �4 No. of Lines ....._../....._.-..--. Length of each ......I------ Total Length ....... <br /> • V Box W.0----- Type Filter Material ACA Depth Filter Material ........... _­.7:--------- <br /> Distance to nearest: Well ------ Foundation ............. Property Line, '........-....... <br /> SEEPAGE PIT Depth ----- Diameter -W........ Number ------------- ----- Rock Filled Y" No [] <br /> Water Table Depth --------------------------Rock Size 0 If........ <br /> L Distance to nearest: Well ........Foundation ....144 e...... Prop. Line ........... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date -........................_-------j _ L <br /> Septic <br /> ...............-------- <br /> Septic Tank (Specify Requirements) ------- ....... ....... ....... <br /> .......... ................. ....... ......... <br /> Disposal Field (Specify 'Requirements) ---................. ............................................ ........:_............­...... <br /> ................ -------------------------------- ---------­--­....................................... ---­---­--------------------- -------------------------- ........... <br /> ------------- ---------------------- .................................. ------------- ----- -- - -------------------- <br /> .................... <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 Son Joaquin <br /> County Ordiniinces, State Laws, and Rules and 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 to become subject to Workman's Compensation laws of California." <br /> Signed ----------- ... ..... ....................... -- --- -----------. Owner <br /> ------------- <br /> By .... ......................... Pile ..... ......... ---------------------- ...... . <br /> f oat�lw_ an owner <br /> R. DllfPi ENT USE ONLY <br /> APPLICATION ACCEPTED BY------ -19 <br /> --------------------------------------------- DAT ---- ---- - <br /> BUILDING PERMIT ISSUED �------ ----- ------i.............MATE --- --------------- <br /> - - ---------- ------... <br /> -------*......... <br /> APDITIONAU'COMM <br /> ------ ------ - - --- ------ ei I..................... <br /> ---------- ----- ---- ............*------... .................. ............................................... ......... --------------- <br /> .... ---------- ------- ------------ <br /> .......... <br /> Final Inspection by; ...... ..... .. V <br /> ............ ....Date ... ... <br /> SAN JOAQUIN ZOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />