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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ' Permit No: <br /> >.., <br /> {Complete in Triplicate} <br /> ------ y Date Issued lvo.�D <br /> ' This Permit Expires I Year From Date Issued <br /> --------- <br /> Application� e San Joaquin Local Health District for a permit to construct and install the work herein <br /> is hereby made to th <br /> described. This application is made in compliance;with County Ordinance No. 549 and existing Rules and Regulations: <br /> Ii ------ <br /> , v <br /> ' . CCG ---- --- ------C- ENSU <br /> S TRACT <br /> CT <br /> SS/LOCATI '�i' ;JOB ADDREI <br /> --�- <br /> �-�Phone <br /> Owner's Name <br /> Address --------------- ---- - --------- -- -- C, - -------- <br /> �q�.:+ . ---•--.License # /00.5//-- ------- Phone 'Y66--- <br /> Contractor's'Name -----------.-------- -- -- -- - - <br /> � Jiff <br /> Installation will serve: Residence�Apartmenl,�Hause°Q:Commercial ❑Trailer Court I <br /> E .F ..'� <br /> Motel Other ---- -- '=---- �---------- <br /> .} r•. , :slP,«-------- -------- <br /> Number of living units:---- -`C Number of bedrooms _ _______-_Gar6ci a Grinder _-_______.. Lot Size <br /> f 1 <br /> g , <br /> If _' � `� -- <br /> Private-•-'''•-"'�'"' <br /> Water Supply: Public System and name ------- --------- --- --- -----------:�------------------------------------ Loam .0 <br /> Character of soil to a depth of 3 feet:i",Sdnd'❑ S0 Clay El Peat[I Sandy Loam Q Cla y <br /> "Hardpan M Adobe,171 Fill Material ------------ If yes, type --------------------------- <br /> s G3 <br /> (Plot plan, show!ngfsize•of lot,..locationwof system-in-rel ation_to'_w.elIs,_buildings,_etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is40available within 200 feet,) �� <br /> V <br /> f / - <br /> PACKAGE,TREATMENT ( I. SEPTIC Size--------- _xT-- ''------------- ---- Liquid Depth ___ ��f---------- <br /> Capae�t ��' � Type - ----- Material 440-A'44.---------- No j Compartments __ ------_---- <br /> . <br /> �Y r Foundation`.--/P------- Prop. Line' <br /> Distance to nearest: Well t- ---------- ;, <br /> a, - - —_- •------------------- <br /> ,�. _ - Tota! Len th <br /> ]�~ _ Length of eadi liner------_--- g <br /> LEACHING LINEOil No. of Lines---,k- -------=-''- <br /> ri <br /> - _ _Depth Filter Material ___-_1- ---- ---------------- - - <br /> •f D' Box :_:-_Type Filter Material ------- ----- -•-- <br /> Distance t6-nearest- Well __!<x4_---f' -- Foundation <br /> --------!.Property_ <br /> f �r Diameter Number -------?�------------- Rock Filled Yes No i0 <br /> SEEPAGE PiT Depth _i-`L <br /> N Water Table Depth -------------- - Rock Size <br /> x - <br /> l v� Foundation sProp dine --------------- ---• - <br /> �` Distance to nearest: Well ____.--_ -- <br /> W,M/ADDITION(Prev. Sanitation--Permit#--=----==_--------==---=--a- ---------- <br /> Date ----------------- <br /> Septic Tank (Specify Re uire c) ----------------------------------- --------------- <br /> r: 1 <br /> p p ' y ,q menu} ---- --------- ------ ------------ <br /> �. o 1 ` ' --- ----------------------- ------ -------------------------------------------------------------------- <br /> Disposal Field (Spewify Requarementsl __ _ , <br /> I { ---- --------------------------------------- <br /> = _•.• L,.. ---------------------------------------------------- <br /> ----------------- ------------------- ---_° --------; -------------- --------- <br /> r <br /> [Draw'&kiiting and require addition on reverse side) <br /> f l hereby certify that I le prepared this application and fn! t, We work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws; and Rulesrand Regulations of,the San Joaquin local Health,District. Home owner or licen- <br /> sed agerits�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 Compensation laws of California." <br /> Signed ------ -- -- -------- <br /> - Owner <br /> r + <br /> ------ -----=----- ------•- lit e - ----- - <br /> [If of than ow - <br /> rierl <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -� ----- <br /> - ----------DAT ---- ----------------- --------- ----- <br /> ------------------------ -- <br /> DATE _lG ------ ------ ---------------- <br /> BUILDING PERMIT ISSUED --------------------------------------- ----------------------------------------------------- <br /> - - <br /> ADDITIONALCOMMENTS -------------------------------------------------------------- -•------------------- <br /> ----------------------------------------- <br /> i------- ---------------------------------------------------- ----------------.----------------------- --------- <br /> ------------ ------------------ --- <br /> - ----- ------- --- ------ <br /> Final Inspection by: .__ ------- ------ ---- --------- --Date ---- --- -- ---------- <br /> )4AQUlN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />