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FOR OFFICE USE: � <br /> APPLICATION FOR SANITATION PERMIT I <br /> -/6--6.cF----- ---------V ,-5-D-------- Permit No. �tl- �S. t <br /> / , 0-� .:, (Complete in Triplicate) <br /> --------------------------------------------------------- µ This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is 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 ma/d�e in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .-- -dam- - —--------��-- i.'��� CENSUS TRACT <br /> Owner's Name -- 1 <br /> L. ��`�� � -71--- -------I--------- hone -- <br /> tl <br /> Address -1 �' ----- ---- ----------------------------- City %.R-416 <br /> , i <br /> Contractor's Name __/ �?/_�_= p �--------------------------- '� <br /> -------.License # �_/2 PhoneX :_.e�9_/ <br /> Installation will serve: Residence (Apartment House-E] Commercial :❑Trailer Court '❑ <br /> Motel ❑ Other -----------------------------------------— / h <br /> Number of living units:---- Number of bedrooms "/�---.-.Garbage Grinder -/VAP- Lot Size`�� <br /> +— _--. !___..------ <br /> Water Supply: Public System and name - a,6/9 d -- ��L� --------------------------------------------- ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .E] Clay Loam ,E] <br /> Hardpan ❑ Adobe- Fill Material ------------ If yes,type ---------------------------- <br /> (Plot <br /> ---(Plot plan, showing size of lot, location of system in relbtion 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 ( I SEPTIC TANK' Siz4oteriaAoole <br /> __"-""---------------- Liquid .Depth " !______.._-."""-- <br /> Capacity J Q�"' Type " -.------ No. Compartments _ _"__: <br /> : We <br /> Distance to nearest- ______ __- Foundation _ �__--__"""-"-.Prop. Line -_e-�""_ F <br /> LEACHING LINE No, of Lines --.--�--- __-"_" Length of each line.""-/ �_""-_"-.------ Total Length <br /> 'D' Box A/a--" Type .Filter Material,/- " ,Depth f=ilter Material _��"-"-"------------ ------------ <br /> Distance to nearest: Well ---.--__-"--_----------- Foundation 2-%07------------ Property Line _- _.--"-:-"-- ; <br /> / <br /> SEEPAGE PIT - Depth .-.2_4f Vr-" " --- Diameter _ ----- Number ___l----------- ------- Rock Filled YesA No 0 <br /> Water Table Depth ---- -----10------------------ --------Rock Size "��" ��------------ r E <br /> Distance to nearest: Well ----------- --------------------------Foundation lellQwp"--"-"" Prop. Line .. p---________ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------------------.----------) <br /> SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------•---------------------------- ; <br /> Disposal Field (Specify Requirements) ------------------------------•------------------------------------------------------------------------------------------ ----------- <br /> ------------------- ---------------------------------------- -------------------------------------------------------------------------------------------------•------------------------------- ----- <br /> ------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 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 liven- <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 C pensation laws of California." <br /> Signed ------------- ------ ------------------------- - --------------------------------- Owner <br /> BY --------- --- ----- - -- ----- <br /> Title -------------------------- <br /> t er than owner ' <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - 7 ZZ-411!-------------------- ----------------- DATE --� . ` � �� ----- <br /> BUILDING PERMIT ISSUED "--r� JetDATE ------------------------------------------- <br /> ADDITIONAL COMMENTS r` �- ..... .5-----X°a`�------.. .. -- - ----------------------------------------------------------- ---- <br /> --------------------------------------- - ----------------------------- ---------- --- ----------- ----------------- ----------I-------------------- <br /> ------------------------------- <br /> ------ -- - ---- <br /> ------------------------------- --- ------------ ------------------------------------------------- r <br /> ---- ------------- • -------------------------------------Date ---o :`� _�-� - = <br /> Final Inspection by: - -- ------- ---- - ----- ---------------- - - . - - --- - -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT t <br /> r <br /> i <br /> E. H. 9 1-'68 Rev. 5M <br />