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f4JK rJFfICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ......................................... <br /> Permit No........................................................ _(Complete In Triplicate) <br /> .. ....... .. <br /> — -7- � <br /> -----------------E........................ ................ This Permit Expires I Year From Daw Issued Dote Issued ........,/..........7.. <br /> Application is hereby made to the San Joaquin Local Health District for 0 permit to construct and Install the work herein <br /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION <br /> 'Owner's Name ..........................CENSUS TRACT ......... .............. <br /> - -------------­I—------ ------- .............. ..............I......................Phone <br /> Address n'l....1­1W..... ----------_-_-__..................... city MIA.xxxmA...... <br /> 7 k--------------- ....... ........... <br /> Contractor's Name sw----4_ '. ...................License # ....._................. Phone <br /> Installation will serve: <br /> Residence W Apartment House f:] Commercial oTraller Court <br /> Motel E]Other................ <br /> ........................... <br /> Number of living units:-..-'-(---- Number of bedrooms ­3-----Garba9 e Grinder ............ Lot SizeCa <br /> I ............................................ <br /> Water Supply, Public System and name -,................................................. ........................................................i.Private <br /> Character of soil to a depth of 3 fedit., Sand Ug Silt o <br /> CIOYO Peot[:) Sandy Loam o Clay Loom 0 <br /> Hardpan [j Adobe 0 Fill Material ............ if yes,type ............... ............ <br /> Mot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit .permitted If public sewer Is available within 200 feet,} <br /> PACKAGE TREATMENT SEPTIC TANK f <br /> Size_.... ............ Liquid Depth ....... <br /> t�,Copacity ..................... Type ------------ ...... Material-----.- ----------_- No. Compartments ...... ...............%A <br /> Distoncerto nearest; Well .------/0'6 ' /() 0 _j. <br /> . .. .... ...........Foundation ...................... Prop. Llne ....,ZA' <br /> .......... <br /> LEAdf1 LING LINE of Line's ...._3------­...... Length of each fine._. ... Total Length _3. .....I.......... <br /> V Box ....... Type Filter Material J�t � <br /> Depth F! ter Material ........... ................... <br /> Distance tonearest: ....... Foundation ....................... <br /> I T" f - Property Line .................... <br /> SEEPAGE PIT Depth �------i­----------- Dibmeter"i_----------... Number- -------------------------_ Rock Filled Yes [I No <br /> Water Table Depth � .......... -------------•..............Rock Size ....................... <br /> i Distance-to,necirest.-WPJI-I.rr:,�I , <br /> .foundation Prop. Line ........ <br /> REPAIR/ADDITION(Prev. Sanitation .Pe i mii <br /> ..........7_�---------------------.-.-.---- Date ........ <br /> Septic Tank (Specify Rec6frements) . --------- ..... . .•..r ..................................... Ape <br /> Disposal Field (Specify Requirements) ......... <br /> --------------- -------------­- <br /> ------------------------------------- ......... ...­..................I.............. <br /> ------------------------------------------- ----------- ------------------------------------------ ...................­1.....................Z� <br /> ------------------- ------------------------------------- <br /> raw exisfs',ng.ond re-44ired a!�ddition on reverse side)---------------------------------- -- ----------------------------*............ ...... . ... <br /> I hereby certify that I have prepared s P' <br /> this <br /> ciiicl'11cation ljhat-the work will be don; in accordance with Son Joaclulti. <br /> County Ordinances, State Laws, and Rules iegulations <br /> sed agents signature certifies the following: Joaquin Local Health,01strid. Rome owner or licen- <br /> "I certify that in the perform_ n;4k of_thtvi�ork. o Cr --jA <br /> co pect , -L �j�c 11_pAkmit shall-ROLemPloy-any-person in, such manner <br /> as to be b* to gman Compensation laws of California." <br /> "Signs ..........I---------k­-------------- ----------- Owner vitJt <br /> 7 <br /> By _......................................... .......... .......... ---------I­----------I------------- Title ................... <br /> (If other than owner) <br /> FOR DEPARTNIF T USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -- --------------- DATE <br /> BUILDING PERMIT ISSUED ------- ----­--------------------- ------------------- --------------- ............... .......DATE '. ------ <br /> --- <br /> ADDITIONAL COMMENTS ....... <br /> ----------------­-------------------­--------- ------­----------------- ­­ <br /> ­---------- ------- -------_­ k, <br /> ----------­----------- ........ ........ ------------------------ ----------- ------------------------------------- <br /> ................­................................----------- ......._ ------------------- ------- - - ---- ----------------------L�---------------- --------------------------- ........................ <br /> ---------- ........ ------------------ <br /> Final Inspection by ---- -- - .. ... • . ............... ........... Date .... <br /> -------- --------------------- ----------*--------------------------------------------------------------- ;�;��Zr_........... <br /> - -------- <br /> EH 13 2h 1-68 Hev- 5M SAN J. QUIN CAL HEALTH DISTRICT......... ---- 8/74 3M <br />