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FOR OFFICE USE, <br /> .APPLICATION FOR SANITATION PERMIT <br /> -_----_--------- ---------- Permit No. <br /> (Complete in Triplicate) <br /> I, <br /> "��his,llermit Expires I Year From Date Issued Date Issued <br /> % 2-ro-1 <br /> Application is hereb;�rnode to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described.,This application is made in compliancerlina*th County nce No. 549 and-lexisting Rules and Regulations: <br /> wi J <br /> JOB ADDRESS/LOC.ATIO <br /> N --------- ------ <br /> .... ................ CENSUS TRACT ...................... <br /> - - ---------- ...r <br /> ......... <br /> Owner's me - _------_----­------------ ......Phone--------------------*---------*------ <br /> Address -h- <br /> Ci <br /> %....... .. .......6�. ----------------- -------- ty ;��d.ye --------------------------------------------------- <br /> Contractor's Name <br /> -x <br /> . .4---- ------------ _License # ......................... Phone .............................. <br /> 4Z 1 `\I tk <br /> installation'wi I).serve: Residenc6,C]Apqrtrrie�nt House CoLmercial Trailer Court 0 <br /> `Z ._/------------ i;.J.. 7 <br /> Motel El Other ........ ........ <br /> Number AN living units-_-!!- _ Number of bedrooms .....G!arbage Grinder Lot Size ............... <br /> Water Sqpply:..Public System and name .......­­--------- .............../ ----------_Private,®................................. ............. ........... <br /> Charocte'r of'sail to a depth of 3 feet- Sana Silt 0 clay [] Peat[:] Sandy Loam 11 Clay Loam.[] <br /> Pon E"I Adobe�3 Fill M�iterial--------- ... If yes,typell__t.................. <br /> (plot plan,f5lowing size 6 i'lloca'floh(kof systern in relation to wells, buildings, etc. must bei placed on reverse side.) <br /> . i 11. f 414 lit <br /> NEW INSTALLATION: (No septic tank or seepage-pit pirmitted if eublic sewer is available within 2A feetJ <br /> PAC 01 ti 0.- za <br /> KAGEiTREATMENT TANK PN <br /> SEPTIC T .......... ...........- Liquia Depth <br /> /401, k q 10, <br /> Material 4&f14V_._.... No. Compartments A�......... <br /> Copecity/4' . ...... Ty <br /> Distance J;too,nearest: Well --------------_--Foundation .)W...............Prop,!Lin <br /> LEACHING LINE No. of Lines -----/...... �Length of each line. =`....... <br /> --------- .......... Total lngtl�4,Z45k'.7 <br /> 'D;' Boxth <br /> . j�' 4_Type.Filte&crterialo?� -----Dep -Filter Material ........ ............... <br /> 4Distarfce.to nearest: ...... Foundation <br /> P ­­.......... Property Linn _729............. <br /> AGE PIT <br /> Diameter, .............. Rock Filled Ye <br /> SEEP Number ..../................. sa' No <br /> b 41 <br /> ---------- <br /> s**/- WaterlTabrie Depth 1__ --------------------------- Rock Size ----------- <br /> ' - -r <br /> Distance to nearest: 'P....... Prop:;Line . ............ <br /> x !ZF-- - --_-------------------------Foundation ZoZ�2 <br /> REPAIVADDITION(Prev. Sonitition Per4t# ........ -------------------------- Date .................................. <br /> :1 1 .09 <br /> Septic Tank (Specify Requirements)-Y---------------- -- <br /> ----------------------- -.-.---•---•-------•--•-••--•--•-•---•---- <br /> ------------­---------*----------------- ----------------------------------------- <br /> DiSposal"field-(Specify. Reg <br /> uiremed's)i ......................................................_-•--••-•••--.........---•-..........------.. <br /> ................................ <br /> We k.* <br /> ........... ------­ <br /> ............................................... ......... -----------------_-------- <br /> ---------- ...... <br /> ------------------ ---------------_------_-------------------- ---------------- 1 <br /> V <br /> --------------------------- <br /> L t *uk a w existing and required addition on reverse side)itior ytcertify that I have.0reparedi this application and that the work will be done in accordance -wit �San Joaquin <br /> C ountykdrdinances, State Lc;;R", iA-4eR.I., and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> ih*1'l,ceIrfify that in the performance of the work for which this' pormit�is Issued I'Inot employLny person in such manner <br /> a"become subject to Workman's Compensationlaws*',,@ <br /> ;df Californla_.` <br /> Si <br /> . .... ............. .. .. nerk IN <br /> - -- - -- ---------- ----------- ---------- <br /> Va <br /> By ...... Tit <br /> 0�702- --- ----- -_ ------- <br /> - ----------------- --------­'­-------------- ------ le *ft"Zkp <br /> (If other t an owner) FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... .................. ID-ATE __*....... ................t.A....... <br /> ......................... ...........................................­------ <br /> BUILDINGPERMIT ISSUED ........................ ...... ..........................................................................DATE ................... ..........1__...... <br /> ADDITIONAL COMMENTS ------- ........... 41 <br /> ............................. <br /> .......... ------ ...........................................--- <br /> •----------•-.-....-•----- <br /> ..................-11...... % <br /> :---------------- --------------------------------------------- ---- I........ <br /> ------------------------------------ ------------ --------------­-------­ ............. .............. ................................................... ................ ......... <br /> -----------------___­...... ---- -----------­­_ ...... --------­--- --- ........ <br /> ------------- --------- - 2 ' <br /> Final Inspection by: ........................................................ ..... ... ... . .... ........... Date ........ 7- ................ <br /> SAN JOAQUIN LOCAL HE tDISTRICT <br /> � ' � <br /> E. H. 9 1-'68 Rev. 5M I kI � <br />