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- .-. - <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT qq <br /> '• Permit No: <br /> -------------- <br /> -------------------------- -------------- (Complete in Triplicate) <br /> 11 <br /> ------ ------------- <br /> Date Issued -------- <br /> ------- This Permit expires 1 Year From Date issue <br /> Application is hereby made to the San Joaquin- ealth District for a permit to construct and install the work herein <br /> Regulations- <br /> described. This application is made in compliance wi}h`Co6nty ordinance No'. 549 and existing Rules and Reg tins:� <br /> ����_ $+r�l�.� _�2-Ca 1 ! CENSUS TRACT 15--5- <br /> :f,7 <br /> G JOB ADDRESS/LOCATION --.-- -- <br /> ----- --.�/�1���4r------- ��__�-/`-T_-.------ ------------ -----Phone -- -------•-----------------•------- .� <br /> - --------- <br /> Owner's Name <br /> ------------------------ -- - <br /> --------------------- -------------------•----- <br /> Address ---------- <br /> License License # ------- - ------- Phone ------------------------------ <br /> ---------------------Contractor's Name - ----------- - -- ------ ---------------- - ..- <br /> Installation will serve,: Residence Apartme t-House O Cammercial,OTrailer-Cert- ,❑----- <br /> l Motel Other _,= "' - <br /> 0 <br /> f I 1 j <br /> Number of living units:_____ __ Number of b Brooms '-----Garbage Grind <br /> .lSize_jA . -__.___ ______________________ <br /> F 1 Private <br /> ------ ------------------ ------ <br /> System and name ------ -------- - ------------------- - - <br /> Wafter Supply: PubFic� •. <br /> Character of soil-to a.,de depth of f3 feet: j y Peat❑ Sandy Loam ❑ Clair Loam ❑ n <br /> p :Sand'i Silt, .Cla <br /> Hardpan E] A8 Fill Material __--_.______ if yes,type <br /> e } <br /> (Plot plan, showing 6e of lot, location o system�in .relation to wells, uildings, etc.-Aust be placed on reverse side.) <br /> r f e. a e it,permitted if public sewer is availa le within 200 feet,) }' <br /> t NEW INSTALLATION:1 (No septic tank o t pag pit, <br /> i i \Size------ - ------ ---- Liquid Pepth •-----------•--- ----.----- <br /> } PACKAGE TREATMENT [ ] SEPTIC TANK ] <br /> v p --------------- <br /> ! --___ Material_______-.___.________ o. Compartments e� <br /> i Capacity i_- - TYp <br /> - =---;:- <br /> .� _ ....- - t I <br /> Distance to Weare t: Wel( ----------------- '-----•Foundation ------ ------ -------- Prop. Line --------------•_ <br /> i <br /> LEACHING LINE [.11 No. of Lines] - ---- -- -- ---- -- LeAgth of each line----------- ---- <br /> - T tal Length ............... <br /> - f - <br /> _Depth Filter terial ---------t <br /> Box .- ----.� T pe Filte Nlateria� ------------- � I j <br /> i -1------- Foundation ---° - Property line .--------•.-------- <br /> Distance to nealo� res : Well __-_�-____-- j y- I <br /> SEEPAGE PIT [ ] Depth `j #DiamI' ' �,_ _-- I-------- Number --------------------- ------ Rock Filled Yes ❑ No C] <br /> Water Table 4Apt ---------- ------ <br /> Rock Size -------- - ------- <br /> 1 --{=.-------------- Prop Line ------------- ------- <br /> iL'Fuhda3•io <br /> Distance to nearest Well ___ ____________________________ __ <br /> f Da e1 i.J- U_--- -- -------1 <br /> REPAIR/ADDITION . ev. Sanitation Pgrrxnit . ----------- - - --- ---------- <br /> i I / - --- <br /> Septic Tank (Specify Requirements) r---------- <br /> W --------------- --•------------------ --- , <br /> Disposal Field (Specify Requirement`s) ./�� _ 1- --- N � <br /> F[LTA_�' 1? = 1Jr ` --'---------- X ST7 �---: <br /> �c <br /> s <br /> ---- <br /> {brow exiting and'requi;ed addition reverse side __ � . <br /> t application and that the work will be done in;:-cc qc a ace with San Joaquin <br /> I I hereby certify that 1 haverepared;�this app ti i E <br /> County Ordinances, State taws, and Rules and Regulations ofd ioa in Loca Iiealt�Dstr • Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of th}�'e work for which this permitisissued, 1 shall not employ any plerson in such manner <br /> as to become subject to Workman's Compensation laws of California. <br /> W . , <br /> r Owner <br /> Signed` ..-•-- ; <br /> Title -- ----------- <br /> --------------- <br /> (if other than owner} � i <br /> FOR DEPARTMENT USE ONLY <br /> _ --------- ------ -------� ---------- ---------� DATE ----�--'----- -------- <br /> APPLICATION ACCEt?TED BY ------ <br /> ©N: --------- A = -DATE �1 <br /> BUILDING PERMIT ISSUED-._-�-"------------- - --- <br /> ADDITIONAf 'COi17-MENTS --------------- --------------------------------- �--------------------------------------- <br /> ---------------- -------- <br /> - - - <br /> --------------- <br /> ----------------------------- <br /> ------ <br /> ------- ----- ---- ---- <br /> - <br /> " f -- <br /> Final Insp b - - -- --- - -- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ...-4 <br /> E. H. 9 1-'68 Rev. 5M __ <br />