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FOR OFFICE USE: f <br /> -APPLICATION FOR SANITATION PERir%1T <br /> . . .............. Permit No. <br /> (Complete;n Triplicate) <br /> --. - ..------ This Permit Expires 1 Year From Date Issued � JA saved <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 /> 13 '2JOB ADDRESS/LOCATION .-....- - <br /> �1 -- l�� ...-.. CENSUS TRACT - ... . <br /> Owner's Name -------------L 4R: ........X1-VOX..........................I......;:.......................... one <br /> i <br /> Address ... .5.1.3-�L R1 - -1 .---.--•R-�. City ..- CALO <br /> Contractor's Name ..... ---- -----•----------- -------License # ----..... . -- .... Phone .. --------.---.-------- <br /> i ' Installation will serve: Residence ❑ Apartment House[] Commercial ❑Trailer-Eswst [�}� <br /> - Motel [] Other .. ............................ <br /> Number of living units:---.---- Number of bedrooms..---...Garbage Grinde��.5 Lot Size .JC}:L�i-f✓-�-�-�---------••- <br /> -- <br /> t ' Water Supply: Public System and name ----------------_-- y --.---Private Ef� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt[� Clay _ `.`.Peat_. 'Sandy Loam Clay Loam D <br /> Hardpan ❑ • Adobe [1], Fil)"Material _-"--.. -" If yes, type ........:......._-----.---- <br /> (Plot plan, showing size of lot, location of system in rel'a'tion to wells, buildings, etc, must be placed on reverse side.) 9 <br /> NEW INSTALLATION: (No septic tank or seepage it permitted if. �blic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK [7" .-Size---. ----------------- Liquid Depth ....7-l3-.............. <br /> Capacity ---- Typet�)? FRB Material-CV!-/VC.R'T—No. Compartments ...................... <br /> stance to nearest: Well -__..., ._1.- ----------Foundation -..1�.. !- -- Prop. Line .-. ---.�------- <br /> Prop. <br /> LINE [�o. of Lines ...... <br /> .- Length of each line..--..�Q--' Total Length -----.16'J'd ... - <br /> D' Boxes- Type Filter Material f�Q ..-Depth Filter Material ..--..1- --------------------- ------ <br /> Distance to nearest: Well .l ............. foundation ..-_LQ". _.._. Property Line ... --.--...-...-.... <br /> SEEPAGE PIT Depth ..--.--- Diameter __",.__. -. Number ......._"."................ Rock Filled Yes ❑ No <br /> [ � P .... <br /> Water Table Depth ------------------------.-R6ck'Size _.-------.----- <br /> 1 i ,Distance t$ nearest: Well -------------------•--..--.-...------...Foundation ....---...-----..... Prop. Line _---.----------.- <br /> REPAIR/ADDITION(Prev. Sdnitation Permit# ------------------------------ --- -------- Date -:-------------..................I <br /> ISeptic Tank (Specify Requirements) ---------- ------------ •----------------- ---=:..-----.-...-"-----...-.... ............-"................ ....".--...-- <br /> Disposal Field (Specify Requirements) <br /> i i 4 1.................. -."" H1-' <br /> ..--........"-..-- .- "".----.- ...... <br /> ...............­­ ­_­­..................... ......­­............ ........ <br /> (Draw existing and required addition on reverse side) <br /> r' I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin <br /> x County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents sign ture certifies the following: <br /> "I certify that the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to becon5lsubiect to W an's Camp nsation laws of California." <br /> Signed _. ..." <br /> h. Owner <br /> By .....".................. �-------...."..--- --- ..-...----- � ........ -----------T-A.o- Title ................."........................-.... ----...... . <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> p c <br /> APPLICATION ACCEPTED BY ...... c-CL,-O- .....--- ......... DATE ----. --L�.- -- - -•- <br /> !�._ BUILDING PERMIT ISSUED ............ .. . ------. ...................---....................... DATE .......-..-....... <br /> r <br /> ADDITIONAL COMMENTS . - <br /> I ....... ....... ------- ---•- -- <br /> 1- <br /> t . ... <br /> Final Inspe � .-.. -...- . Date _... --. �. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F H 9 1.'68 RP.V. W <br />