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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------ - ------------------- Permit No: <br /> (Complete in Triplicate) <br /> --------------------------------- --------------------- <br /> Date Issued <br /> This Permit Expires I Year From Date Issued <br /> ----- ------------------------•--------- .-- <br /> Application is hereby mad&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 /> 0 ../ S. -S701. <br /> JOB ADDRESS/LOCATION 1114W-------wi.......RV64iv-----n- -17--------- ------1 =---------------CENSUS TRACT ------------- <br /> , , 9, 7- 3 <br /> Owner's Name ------/,_'O-----------My�_V-e-r.-;$--------------------------------------------------------------------------Phone ------------------- ------- -------- <br /> 1 15, /?!--J.7 V/Y i I <br /> Address Y1W lk__,Aell�------------------------------ city ------------------ <br /> ---------- --------- --- ------------------------------------------ <br /> Contractor's Name --- <br /> --- ------- <br /> ------------- ------------------------- 1icenteVY0'. ---- Phone 4? ------------------- <br /> Installation will serve: J­Rg-sid6F-ce[N Apartment House-E] ComMpr6a[,,'.EJ1r.9iI&r Court !0 <br /> Motel F-1 Other -----------------------------I-------------- .1 <br /> Z_ <br /> Number of living units:----./----7Numb;r of bedrooms -__ _____Garbo Garba.ge Grinder LotSize -------------------------------------------- <br /> Water Supply: P.ublic System and name ---------------------1-----------------------------------------------------------------I---------------- ------lPrivate Eil <br /> Character of soil to a depth of 3 fe't: Sand's Silt F] Clay E] Peat E] Sandy Loam E] Clay Loam E] <br /> Hardpan ❑E ,Adobe-E -Fill Ifes,-type ------------- ------ <br /> {Plot plan, showing size of lot, location of system in relation to wells, 66ildings, etc. must, be placed 6n reverse, side.) <br /> NEW INSTALLATION: (No septic::tank or seep-age pit permitted if publid sewVlis available within 20; feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANKf I 'Size.----------------------------------------------- Liquid Depthl ---------- IN <br /> Capacity I .......... <br /> - ------------------ Type -------------------- Material---------------------- No. Compartments -•-------- <br /> Distance <br /> .--------Distance to nearest: Well ____________________________________Foundation ----------------------- Prop. Line ----------- ____._. ., <br /> LEACHING LINE Na. ofn -- <br /> Li I -_ al 1 <br /> es ------- ------- ------- Length of each line_---------------------- -_ T at Length _ --------------- ---------- <br /> 'D' Box --------- Type Filter Material ___________________Depth Filter Materi6l ---------- ---------- <br /> Distance to nearest: W611 ---------------------—'Foundation ------------------------ Property Line --------- ---------- <br /> SEEPAGE PIT J Depth -----I--------------- Diameter ---------------- Number -------------_- ---------- Rock Filled Y ff es flo 0 <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest-. Well -------____________________________-_Foundation -------------------- Prop. Line ------- ------- <br /> REPAIR/ADDITIO'k(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------------_1 <br /> I <br /> Septic TankISpecify Requirements) ........12o0__G.t9,L------55qP_h--5�____76N_A-- ---------------------------------------1--------------------------- <br /> 1 0 It I - <br /> Di sal Field {Specify Requiremenlis) ---------_ - ----- ------ ---- <br /> -AUM---ITO _F_�PWP-1/ IN-EW <br /> 1C, -A N. . .....4----Lr=R-0.4 L4J I'L <br /> -----X-7A -A ......#___24 --------- 4Cr......S4__ K ------ <br /> ------SE_ ta____�ftwla......BA%A4. R-mm- --- ------------------------ ------------------------------------------------------------------ <br /> _r(Draw-existing and required addition on reverse side) <br /> I hereby certify that I have prepa red this application,-and-th atr-the-work-.will,be-done.-,in..Accordance with San Joaquin <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: <br /> "I certify that in the performance of the work for which this permit is issued, shtill not emp y any person in such manner <br /> as to become subject to Workman's Compensation Idws of California." <br /> --------- Owner <br /> Signed ---------------------- <br /> Title ----------- -------------------------- ---------- <br /> By_-- -- --- -------- -------------- ---- <br /> i <br /> (if 6f1ier-than:_6WXn <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Rno------ -------------------------------------------- -- ---------------- DATE ---- <br /> BUILDING PERMIT ISSUED ------------------------------------------I <br /> ----------------------------------------DAT <br /> -- ---------- ------------------------------ <br /> ADDITIONALCOMMENTS --------------------- ---------------------------- ----------------------------------------------- --------- --------- <br /> ------------------ -------------------- - ---- ----- --- -----------------------------------------------I--------------------------------- ------ -- <br /> V____ -------------------- <br /> -------------------- ----- - ------- ----------- --- ---------------------- ------------------------------------I------- <br /> ----------- <br /> --- --------------------------------------- --------- <br /> ---- --- - ----- - -- --- ----- --- <br /> -------------------- <br /> -----------------------_------------ ------.Date ------- -- ----------------- <br /> Final In <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'48 Rev. 5M. <br />