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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No: --- - <br /> ------------r -------------------- (Complete in Triplicate) <br /> �' Date Issued <br /> = �-=------ ------- <br /> ------------------------------------:_J <br /> This Permit Expires 1 Year From Date Issued <br /> l .the work herein <br /> construct and <br /> lication is hereby made to the San Joaquin <br /> witE�Counalth District <br /> Ord nan a No. 549ermit oand existing Rul'estalnd Regulations.. <br /> App ' <br /> described. This application is madecompliance <br /> 1- = ------- -- CENSUS TRACT ------ /------------- <br /> _ �fl/-V r <br /> JOB ADDRESS/LOCAT ON --- -- ------- <br /> Phone -------------------------- --------- <br /> Owner's Name ------ -A---- C � C-�=- i <br /> Address ._ ------ ---- -�--� -- ------- - - -�-------------- - <br /> --------------• City <br /> ';- <br /> `!- <br /> A �------------------ License # �.�� �7�Phone <br /> Contractor's Name ____'_ -_ �--amu f� <br /> Installation will serve: Residence ❑ Apartment House[] Comm rciall:❑Trailer Court i❑ h C # <br /> Motel ther __ --- <br /> [YO -- - _ <br /> 1� ---- - <br /> Number of living units:_— - Number of droomst\-- <br /> Garb MG , der ' - tot Size� - -� <br /> - "' =w Private ❑ <br /> 3 <br /> Water Supply: Public System and name --_ ---- --- - 1 , <br /> Cl y ❑ Peat❑-ti.-Sand?y Loam ❑ Clay Loam <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ ; <br /> --- e ---------------------------- <br /> must be <br /> ❑ Adobe � Fill Material ____`ff yes,typ , <br /> Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc. must be placedeotn reverse side.} <br /> { p <br /> NEW INSTALLATION: (No septic tank or seepge pit permitted if public sewer�is available within 2Q0 / N-1 <br /> 1C TANKJ( Size--- ` -XF0,12 <br /> : ; --- Liquid Depth -�--• <br /> -----.--- {� <br /> PACKAGE TREATMENT [ - <br /> SEPTIC --- Type !/YE (?"t Material L_�~ o:Compdrtment3 ---` -- <br /> ,���'7�1, to Capacity ' YP �_ da <br /> O ------ -- Pro Line --- ----•--=--....� <br /> DW+N� Distanceito nearest: Well _ Foundation __ ____- p• <br /> Length of e- -h line------ -- <br /> Total ,Length --- --• ---'------------ <br /> No. of Lines ------I-------------- ` qFQ - # <br /> LEACHING LINE i I ! <br /> '{ e Filter Material epthFilter� Material .-._l- i---- <br /> 'D' Box - Type <br /> I # l Pro er Line -�--__. -1' <br /> fr` Distance to neaIest; Well ------ <br /> ---_----- -- Foundation __._ P h! _ <br /> Diameter - f ---------- Rock Filled Yes J� No . <br /> --�----- Number ------- - � <br /> SEEPAGE PIT [ '� Depth _� ----------- /f <br /> - (�' Rock Size __ �Z._X _-------- J <br /> ' Water Table Depth ------- b - ---------- <br /> ,.- / <br /> i Foundation �-- ----- Prop. Line .-�---------- <br /> Distance'to nearest: Well } ` <br /> Date ------- ---------------------) <br /> REPA4R/ADDITION(Prev. Sanitation Permit# -------• ----------------------------------- } <br /> ------------- -11 �} <br /> i <br /> Septic Tank (Specify Requirements) --------------- t <br /> ----------------•--------------- -------- <br /> Disposal Field (Specify Requirements} ------------- -r� '-, <br /> -----------------------------------------��------------------------------------------------------------------------------ <br /> i ---------------------- <br /> 1 -------------------------------------------------- <br /> - ------------------- <br /> ____ _ <br /> = ------- ------------ -------------------------------- <br /> '� [Draw existing and required addition.on"reverse side) <br /> I hereby certify that I have prepared this application and that the work wi11 be done in accordance with San Joaquin <br /> ' County Ordinances, State Laws; and Rules and Regulations of the San'.loaquin Local Health District. Home owner or licen- / <br /> ------ <br /> sed a�ents.signature.certifies-the-following:-�--- p y arson in such manner <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any p lifornia." 1 <br /> as toybecome subject to Workman's Compensation laws of Ca <br /> Owner , <br /> Signed ---------------- ------ - ----------------- - --- -- ----- <br /> Title ��"---- r . <br /> l B =---------------- - W, I. <br /> - -- ---------- <br /> Y [ (!f of r an ow r) <br /> F EPARTMENT USE ONLY <br /> I ----------- <br /> ------. DATE -~/ ---------------- <br /> APPLICATION ACCEPTED BY .___-- ( ------------- <br /> BUILDING PERMIT ISSUED -' --------DATE <br /> ADDITIONAL COM NTS -- -- ------- - - ---- ------------------------------•--------------------------t--- ; <br /> [----------------------------"-------------------------------- <br /> �r� j <br /> __ __k__ <br /> - _________________________________________________ !------------------------------------- <br /> - <br /> __-____.__-______ - _________ <br /> - ------------------------ ----------------------------- -Date)-� -- <br /> Final Ins action b <br /> Y ;.a --------------------- <br /> p <br /> A�J AQUIN LOCAL HEALTH DISTRICT. f <br /> c� E'-H-. 9_ 1-'68 Rev. 5M <br />