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-F6k-bMFIC1f Ott, <br /> APPLICATION FOR SANITATION PERMIT <br /> .......... ....................... ............ Permit No. <br /> (Complete In Triplicate) <br /> This Permit Expires I Year From Date issued Date Issued <br /> ........... .................-................... <br /> Application is hereby made to the Son 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 /> L <br /> JOB ADDRESS/ OCATION ................. . . ................CENSUS TRACT .... <br /> Owner's N <br /> ...... Phone I <br /> ........... ...... .................. <br /> Address <br /> ------14/2.7........le5 ........ =.,z ... ..... ...... city <br /> < -- - / ------- ............................... <br /> Contractor's Name —....060. (e�e .7��-----------------------­--------------.1-letrise # --------- -------- Phone <br /> Installation will serve. 1. Residence*Apartment House,E] Commercial E]Trailer Court 0 <br /> Motel []❑Other ------------------------------ <br /> Number of living.units:...../_:'._ Number of bedrooms "_"""Garbage Grinder ....... Lot Size .................`4 <br /> Water Supply. Public System and name .... <br /> ---------.................................................................. ...........Private 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay [-] Peat 0 /Sandy Loom (D Clay Loam E] <br /> Ill. i <br /> Hardpan E] Adobe Fill Material If yes,type ...... ....... ......... <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,) side.) <br /> PACKAGE TREATMENT, [ ] !`SEPTIC TANK Size---- ............... Liquid Depth .".-/- <br /> ---/- 6./........... <br /> Capacity ..44.0.0...... Type Material.......43V.U.444 No. Compartments ---4.............. <br /> Distance to nearest: Well .... .........~------•----------Foundation ----------- Prop. Line ---------------- . <br /> LINE No. f Lines ...... Length of each line... ....PO. <br /> o ............. Total Length ......... <br /> M ......... it r Material ......................... <br /> 'D' B61x ... t�Oe Filter Oterial . . ..........Depth Fi er ................ <br /> Distance to nearest; Well --- .......... Foundation ..... ............. .... .Property Line ------- ................ <br /> SEEPAGE PIT Depth. . . .... ...----- Diameter .................Number ........ ............ <br /> : --. Rock Filled Yes C] No C) <br /> Water Table Depth --------------------- -.I- <br /> ...... ............ Rock Size -........ --•- ------ <br /> Distance to nearest. Well ...............I----------- -------------Foundation ........ Prop. Line ...................... <br /> Date ---k_____________________ <br /> v .........----- I - � . -1, --- <br /> .z.REPAIR/ADDITION(Pre Sanitation Permit ------ .............. I....... <br /> SepticTank (Specify Requirements) ....... --------------------------------- ------------------------------------ .................................. <br /> Disposal Field (Specify Requirements) -------------------------------- --------------------- <br /> ........................ ......................... <br /> ji <br /> ................ ............................... <br /> ---------------- ----------------------- ------------------------ ---------------------------------------------------- <br /> .................... ---- ---- ....... ........ .. ....... .......... ------------ ----------------- ---------------I----------------------- <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 San Joaquin I <br /> County Ordinances, State La W's, and Rules and Regulations of the San Joaquin Local Health Distrief.' Home owner or (icon• <br /> sed agents signatu6i certifies the following: <br /> certify that in,-the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> 014g\n-W �oicosobjdc'r Wric'man's. Compensation laws of California." <br /> Si <br /> i ii ................... --------- OWr:ier <br /> By ...... ..........-....... ---------- ............... ...... Title ........... ... ..... ............ ............ <br /> lif other than owner) J <br /> It DEPARTM T USE ONLY <br /> APPLICATION ACCEPTED ... ............. . ... ... .............. DATE 11-AY7 ..... -------- <br /> DEP <br /> BUILDING PERMIT ISSUE . <br /> ............. -------DATE ........ ....................... f. .. -------- --------- ------ <br /> ADDITIONAL COMMENTS <br /> ............ ------------ ......................... ........... ....................... . ... ............ <br /> - -- - <br /> - - ----- ... .. .. . . ..... .. <br /> ....................... -------- -I................. ------ . . ... .. ---------------------- ..................--........ <br /> ............................................ .............................. ........ ....... ........--•.... ------- .. ..... ..­-­­...... ............. <br /> ----------------- <br /> ------- - ------ - ---- ------------------ ......... <br /> -- ------------- . ........ ............................... <br /> Final Inspection k <br /> - .....................----------------I................. ---------- ........... .Date <br /> SANJOAQUIN L LOCALif HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. SM 7/72114 <br />