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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> (Complete in(Triplicate) <br /> ---------=-- ----------------------------- <br /> Date Issued <br /> s ------------------___--------- ---- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir, <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .--------J7%2.2----I-------"�---------H, �.'R ------AD -------CENSUS TRACT <br /> Owner's Name -- ----1l E............... <br /> ------- . -� -t�--�- E-K----- --. ---------/----------------=-=---------- Phone ------------------------- <br /> -----------­- <br /> Address <br /> ---------------------- <br /> ^-� c i <br /> Address -----------1 'Y-0-_��___--------1?_--------H_-'��--f�[-R-- ------ - ------ • City -- FSC/9-1-ON---------------------- = <br /> 6, <br /> Contractor's Name ----OVV-1V5�]---------------------------------------- ------.License # ------- ----------------- Phone ---------- -------------- <br /> - <br /> r �} <br /> Installation will serve: Residence Erx-partment House❑ Commercial ❑Trailer Court l❑ ; <br /> Motel ❑ Other ------------------ •----------- <br /> > _GI� � <br /> ,Vi <br /> Number of living units:--:/------- Number of bedrooms r_...Garbage Grinder Lot Size IJ _CA6_- •-------- <br /> Water Supply: Public System and name ---------------------------------•------ ---------------------------•--------------------- .........%; =-_-----Private �r <br /> Character of soil to.a;.depth of 3..feet:_,..Sand:'0, Silt E-] Clay. ❑ a Peat Sandy Loam Clay Loam :❑f <br /> E Hardpan 0 Adobe ❑ ,Fil Material if yes,type ------------------------------ <br /> f <br /> (Plot plan, showirtlg size of lot, location of system in relation`(to,iwells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage Dit permitted.:if public sewer is available within 200 feet,} y <br /> PACKAGE TREATMENT f ] SEPTIC TANK:[ I Size_----------------------------------- ------ Liquid Depth <br /> Capacity -------------------- Type Material------------ --------- No Compartments -----------------:.._. <br /> Distance to nearest: Well ----------------- ---- ---------'`-Foundation -__-"--- ----------- Prop. Line --_ _-----.-.___--_-.- <br /> LEACHING LINE [ } NDo.BoofL Ines- ---- -- Filter Length of each line `:---_--=--===_--' Dial Length-'---------------------------- <br /> .S <br /> ype <br /> Filter <br /> -- Material --- ----------------De'pth Filter Mate ial --------------------•-------------•--------- <br /> Distance to nearest: Well - _---M--------------- Foundation --------I--- Property Line ---------------------- <br /> SEEPAGE <br /> --__--_-_-_-_ .-. ---SEEPAGE PIT Depth ------ ---- ter ---------------- Number -----_--_.__s _-.----.- Rock Filled Yes ❑ No <br /> --------- Diame �. i <br /> Water Table Depth ----------- -------------- -------=------.-Rock Size '----------- ----------- ------ r <br /> Distance to nearest: Well --- -I -----------'----.----------------Foundation -- ----I --------- Prop. Line --------------- ...... ' <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ---------- ' --------------- --------------- Date -------------- ------ -----------} <br /> Septic Tank (Specify Requirements) -------- ---------- ----------------:-------------------------------c----------- ------------------------------,,.--------------------------- i <br /> Disposal Field,, (Specify Requirements) -------FRO Pi,!4.------- �---- <br /> _AA G- C�l+7 ,S '=I = --_- --- -- ------- ---- <br /> *, <br /> ------------------ - - - - <br /> --------------- <br /> (Drawpistin ;and re wired addition on reveBeside) <br /> PIT <br /> I hereby certify that I have prepared this application and that 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 liven- <br /> sed agents signature'yifieshe following <br /> "I certif t in the,� nte of he work for which this permit is issued, I shalt not employ any person. in such manner <br /> as to b c jesublecl man's ompensation laws of California" <br /> Signed ------ - - ------------------------------------ Owner <br /> By ----- -------- --- other tli------------------------------------ --- -------f--1-R--- '------ -Title ------------------------------ ----------------- ---------- ------------ <br /> ---- -- --- ------ <br /> an owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ± DATE '` -'•- ��-- -- <br /> �tJ ----------- - - <br /> BUILDING PERMIT ISSUED ----------- e ` -DATE -------------•----------- ---------------- <br /> ADDITIONAL-COMMENT - = =C _ !�_ -__Cf— X I_i _X._I Z- -____________ ____� <br /> -------• C, 1•�-... ---------------------- <br /> -------------------- -------------- ----- -------------------- --- ---- ----- --------- ------ ------------ <br /> ------------------- <br /> ---------- <br /> - - — -- —-. L.- - .._ - ------------------ - <br /> ��. <br /> Final Inspection b ----- ---- - --- ----- -- ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />