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FOR OFFICE USE: <br />-APPLICATION FOR SANITATION PERMIT /7 a <br />{Complete in Triplicate} Permit No.. <br />-...._................ ...._-_.-__.____ Date Issued_.___.. This Permit Expires 1 Year From Date Issued _y <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_, --�-�GA��'C�"s,�:ii-�-_.._..............CENSUS TRACT----�----_-----�.. �, <br />Owner's Name .. - C.(_r7C.. .---.-.._.�^_............... .....Phone V6.Y-7r�� V----- <br />Address ......_.. l°a� ........ la�: �._. City _ ..e�._+w�v`'l - -------------- ----- +e <br />_, ' �^r <br />Contractor's Name .............. -_ _-- -.._.. - -- _- --- ... ; . _License #,1'� r.� t ..--- Phone .'104J�7 a <br />Installation will serve: Residencei'' Apartment House] Commercial :❑Trailer Court iE! r <br />Motel ❑. Other ------ ---- ...... 2� ----_----•- f <br />Number of living units; --- Number of bedrooms�,f._.____Garbage Grind ........ Lot Size�x.1 i� <br />----------- .......... <br />Water Supply: Public System and Warne ............... -• --• .. . I__ ..-.i ...... ........ --•-- Private ❑ <br />Character of soil to a depth of 3 feet -. Sand Q.�Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ <br />Hardpan ❑ , Adobe(- F.01 Material --------- If yes, type .-............ <br />-------.--- <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: jNo sepfic tan seep-d&-pit„permittea`if public sewer is available within 200 feet,) I: <br />PACKAGE TREATMENT r SEPTIC TANK Sie-. <br />1� L } \---'.}----�----.-.__.... _..----._�---- - Li4uid ~Depth....s----•--•-----•--.----• <br />Capacity --._ ------------ Type ............. Material Material._ 1r__.--.._., l No. Compartments ........... .......... <br />%{ Distance to nea`est:,µ1Ne11---,.--.------..----- ------.-------faun ation .._----..-...._-..-- Prop. Line-_---- ...... :...... <br />-.' <br />LEACHING LINE [ ] I No. of Lines --_-_ -_-- ------ `� Uength ofeach line; ":�-- -- -------.._�-._. Total Length .._,..._-•--•................ d i <br />D' Box ----Typ `Filter Material ----.-':_-- D"+�pth Filte'r�'Material.._._.N.�.:_..,---� <br />Distance to nearest: Well ._..___._ _. __nd <br />Fouation _ <br />.... __ Property Line . ......................... <br />SEEPAGE 1'IT [ j Depth Diameter .._.-_ .__... Number _.................. _.__ hock Filled Yes Q No Cliri <br />Water Table Depth ---.... --------Rock Size ------- ... ... ___ ........ <br />++ � Distance to nearest: Well :•.ft�'_. �'_..__.._:..............Foundation ._._------ Prop. Line ... ..___...__.___..._ <br />REPAiR/AQDfT1ON (Prev, Sanitation Permit #--- ---1 <br />............... --.1. ...... .--- Date ..._.------.-•--•-,----._.._-. } <br />-- - - , <br />Septic lank -[Specify Recl irernents)�- k'ti = i� l,�t l ------- <br />pt <br />--- .... L <br />Disposal Field (Specify egwiremenfs)_.._. __ 'T_0.__ <br />-t.-a�'�- ......... <br />-------- - - - ? '�` _. _ ri _�. � -_ ------ .-._-_----- - <br />--------------- . _. _. <br />F {Draw-existing_and..required„ciddition 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 l,' <br />County Ordinances, State Laws, and Rules and Regulations of -the. San Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: --•9'1-' <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 .t <br />as to become subject to Workman's Compensation laws of California." <br />Signed ...... ... Owner i <br />BY ------- ---. � _ .Title -------_--- <br />(!f other th owner) <br />F PARTMENT USE ONLY <br />APPLICATION ACCEPTED 9Y ------ <br />- ......................... - _....__. DATE _.. = s7 - ......... <br />BUILDING PERMIT ISSUED ..... f ......... ............DATE .....-------- .._ ----•- <br />ADDITIONAL COMMENTS ......- ......... ..... i' <br />----------------------- ----- ...._ ............. ------_ -----••--••--- :-- -........................... .... ........ <br />--------- ........ .......... ------.._ .......-----._......................... <br />- ---------------------------- <br />--------------..... ------ <br />_ <br />Rnal Inspection by: Date ...._. <br />-----------------------­---- ----------------- •------- -- <br />N JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1 •'68 Rev. 5M <br />�r <br />