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FOR OFFICE USE: ` I APPLICATION FOR SANITATION PERMIT <br /> Permit <br /> , � (Complete in Triplicate) <br /> ..................... ----- ­-------------- <br /> '., /and <br /> ate Issued .. ._'.Z.--.z � 2- <br /> -- <br /> --_.-_-._.------__---.----- This Permit Expires 1 Year From Date Issued <br /> Application is reby made to the San Joaquin Local Health District for a permit to cot and install t work herein <br /> described. This licatioii is made in compliance/with County Ordinance No. 549 andting Rules and egulations: <br /> 71 ��i l`[�i4 �. .............. ENSUS TRA <br /> JQB ADDRESS/LOC ON . . . .. - - /- - <br /> ----. ... ------ -- <br /> A O/2AwPF�✓�� GOGF'> ePhone . .:./ . <br /> Owner's Name - - ------. ... . ............ .. <br /> t� -- ' <br /> Address _._....-y 7.7 -- ---- -----`--"-._-----V .....---..----'------. City <br /> Contractor's Name ----------- ..-. ..-.-'---------------------------------------------------License# ......_. ....._.. P ne '----------------_----- <br /> Installation will serve: R idence❑ApartmentHouuuse❑ Commmercial ❑Trailer .�Motel D'Other _-../�4 '�. .5ILS,..-__._.. Q� QNumber of living units:_..-..--... Nu b r of bedrooms 3..._.Garbage Grinder ..._.._-__ iz .-_..-Y.. �-'-!.-� "�Water Supply: Public System and no e . _---. /c/f/L�_�[.'"�.-`--�`-.:�.-dl -...--__-_..-. .............-----'-Private ❑Character of soil to a depth of 3 feet: a ❑ Silt❑ Clay ❑ Peat❑ Sandy ❑ Clay Loam ❑Hard Adobe ❑ Fill Material _-_-...... If yee .._._._-___............. <br /> (Plot plan, showing size of lot, location of em in relation to wells, buildings, . must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or see pit permitted if public sewer is ailoble within 200 feet,) If <br /> PACKAGE TREATMENT k SEPTIC TANK[ I Size.-y.._x�C x. ------ .--_.._.. Liquid Depth __r.1 X V <br /> Capacity/.%20�.. pe ._.__-.._-._-. Material ---- ----- - -- - No. Compartments _ ............ .. v <br /> I / <br /> Distance to nearest: Well ------------_--Fo d - ----- Prop. Line <br /> LEACHING LINE No. of Lines .......�.....--._. Len h of each line ._.-_-.._.. ... ... .. Tot'al Length ... / ..__. <br /> 'D' Box ---j...... Type Filter Materi .,,e'.(�d.. _Depth Filter <br /> Distance to nearest: Well .--- 'O .-. Fou ation /.... ............ Property Liner............ ... <br /> SEEPAGE PIT— Depth __...........__. Diameter ------------- mber Rock Filled Yes ❑ No ❑ <br /> Water Table Depth ---------------------------- ----------Rock Size ------------- ---------- <br /> Distance to nearest: Well ----- ................ _..... ...... Foundation _._-_ ------------ Prop. Line ...._................ <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ......................... .... ___ --- Date ----.-----------------------------I <br /> Septic Tank (Specify Requirements) -- _.............. .......... --- ----------------- <br /> Disposal Field (Specify Requirements) ---------_-------- _ ----- --------- ___----------------.....___.._ ------------ -------._..------.- <br /> ------------'.----..._.................. .------- _.... --- ...... ----- -----------------------....... .......---------------------------- ---------- -...---........ ---- <br /> .......... I . ...........--.----- ---- ...._.—__..-.. _ --------------- ------- --------------- ---------------------------------_.--------------------------. <br /> (Draw existin nd required addition on reve side) <br /> I hereby certify that I have prepared this app' ation and that the work will b one in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules a Regulations of the Son Joaquin Lo Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the rk for which this permit is Issued, 1 shall not, ploy any person in such manner <br /> as to become subject to Workman's Co ensation laws of California." <br /> Signed .....���.1. .------------------------- ----------- -------------- <br /> ------ Owner <br /> By ___..................................... .. _ ..... - - - Title ...... <br /> (If other than ow r) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .�- - --------- ------------------------- ._..--.-------- DATE _._7�.. <br /> - - <br /> BUILDINGPERMIT ISSUED -...--- ---------------- --------------- - .. .---------..... ............... ------------.DATE . - ----- --.._..------------- <br /> ADDITIONALCOMMENTS ..........------._------------------------.........................._-----------------------.......-___. .................. <br /> r <br /> -- ------------- <br /> ._..-----._..._..-----._.._-_._...-....-- ------ <br /> - ----- <br /> --------------------------- <br /> -- <br /> ._. <br /> Final Ins ection b -- ---- -- -- --------------------_........--'---'---Date � `(..a-pr...------- <br /> OAQUIN LOCAL HEALTH DISTRICT <br /> p Y� - - <br /> d- SA <br /> G �� <br /> E. H. 9 1.'68 Rev. 5M <br />