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- - FOR OFFICE USE:� ° '� <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------- <br /> (Complete in Triplicate) Permit No: -_--. -::�?.y <br /> - r This Permit Expires T Year From Date Issued Date Issued <br /> } <br /> Application 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION --- 2I.7------E-----------ENl-pl ------------- SC --- ----CENSUS TRACT ----- <br /> 0 11 <br /> Owner's Name --------- `f-QIV1l -S----------40V_�-------------------- -- -- ------------- -------Phone <br /> City _. C.. -- <br /> Address ------ -------Z 52- - EIVI U4ll _ F <br /> _-=- <br /> - „ . <br /> Contractor's Name ------ V --- l.��--------------- � --------- Phone ----------------- ------------ <br /> Installation will serve: Residence artment House Commercial <br /> #ailer C <br /> p ❑ ❑ Court ;❑`�� <br /> -� j <br /> Motel ❑,ether-------------------------------------------- <br /> Number of living units:----.I------ Number of__bedros,-r�__Garbage Grinder --_ Lot Size -.�CRFi9 �:_---.._.__ <br /> t <br /> Water Supply. Public System and name ------------------------ _ __----------___-- _ ------ <br /> ----------•-------------•----------------------Privato <br /> Character of soil to a depth of 3 feet gr1d'❑�YSilt.!❑ Clay ❑�j Peat❑ Sandy Loam ❑ Clay Loam;� <br /> • Hardpan Adobe-E] Fill'Materia17V_0_27-If-yes;=type'` <br /> (Plot plan, showing size of-loft, location of system in relation to wells, buildings;etc. must be placed on reverse side.) <br /> NEW INSTALLATION: �{No­sepffc-ton k-or-seepage--pit_.permitted if public sewer`is available within 200 feet,) <br /> PACKAGE TREATMENT` [ ] SEPTIC TANK,I Size-------------------- f'----------.------------ Liquid Depth -------------------------- <br /> Capacity -------------------- Type ------------------ -' Material No. Compartments <br /> Distance to nearest: Well-- _,;__ '___:-°'- '--F----Foundation_--:-- --------------Prop. Line ----------.------------ <br /> LEACHING LINE [ f No. of Lines__------------------------Length--of each line- ------_------__.____---Total Length _---------- <br /> )- 'D' Box ------------ Type Filter Material --------------.-- _Depth Filter Material -------------------------------------------- <br /> Distance to nearest: Well -_,:_ Foundation ------------------------ Property Line _---------.-_-_---.:_-_- <br /> SEEPAGE PIT [ J Depth ------- Diameter ---------------- Number _.____..-.- Rock Filled Yes ❑ Na 0 A�, <br /> Water Table De th"-_Z- 'f(__=_!_ <br /> p <-.�` -------#------Rock Size --------------------------------- <br /> Distance <br /> ------------------------ •-Distance to nearestnWell=--`-_ __r'_- -_.._-Foundation ---------------------Prop. Line _.------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- <br /> �_-- Date.---------- <br /> Septic Tank (Specify Requirements) -------- is --._ pk--_------- ,jam ' 'zS� LiN�_---___ <br /> _ ( I L? 4�__H------- <br /> eld (Specify Requ�fements) I -------- .i <br /> is osa Field-' _ <br /> P <br /> r� �• r <br /> -------- l ...... j`..... ���--Fj _ <br /> i '� <br /> w-__--__-•_ - - .._ <br /> (Draw existin and re wired addition on reverse side <br /> 1 hereby certify f6at I, have prepared this application and that the work will; be done in accordance with San...Joaquin y <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. }come owner or,licen- <br /> sed agents signafure certifies the following: 11 ` <br /> "I certify th a perfor once of the work for which this permit is issued,iI shall not emptay any person in such manner <br /> as to bec Iiject t orkman's Compensation laws of California." <br /> Sig ------------ Owner <br /> By -------- ------=----` ............ <br /> ' - = i <br /> 'p <br /> - ------ -=-------------------- --------------- Title . =---- .` --- ----!(Ifother,than owner) <br /> _4 � <br /> C-- <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY t R--`-----------------------------------------------_-_J-------------------- DATE ------ �C <br /> BUILDING,PERMIT ISSUED - _ --------------DATE ------------------------�.,----__ <br /> _ <br /> ADDITIONAL COMMENTS'-w"r.` "-- "" _ <br /> ---- --•----------------------- <br /> --------------------------- <br /> ------------------------ <br /> .i� <br /> ------------------------------------------------ <br /> ----------------- ------ \--4-- -- - <br /> - ------ -------------------- <br /> __--- ---- -._v. _ _ _. <br /> Finallnspe Date .- -------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT k <br /> E. H. 9 1-'68 Rev. SM. <br />