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36 FOR OFFICE USE: `T � � � - p APPLICATION FOR SANITATION PERMIT 2 2. 6 ------------------------------ # Permit No: Z (Complete in Triplicate) ----- _------------------- -1-...------------- - ------------------------------------------ - -----_------ !f, This Permit Expires i Year From Date Issued Date Issued Application is hereby made to th4ari Joaquin Local Health District for a permit to construct and install the work herein described°�is application is made,ib compliance with County Ordinance No. 549 and existing Rules and Regulations: � :. �3$� d_ - - �-i--------------------- CENSUS TRACT S/LGCATION . _ ___._ OwB er'DS Namt$ e' .� -a--- ------Phone ... ------- 'A' - - - Address -------- --------------- -----I . Contractor's Name- 77t�,, -Znv�:5/ --- Phone4io� knstallation will serge '� ' "Res deuce ❑Apartment Ho"--- mercial [7]Trailer Court ;❑ ber-of iivirig units:----- Motel ❑ Other ----------- ------------- 4-Number-of, -------------- ----- Number of bedrooms --.--_- _--Garbage Grinder ---. Lot Size -------------------------------------------- �,Watk� �. . _ - um �` er Suppfy: Public System and name ------------------ ...... ________________Private ❑ " / Q—{_---- Ch�racter:of soil to a depth of 3 feet: Sand'❑ Silt❑ C ay ❑; Peat ❑ Sandy Loam ❑ Clay Loam:❑ 1 ,t , J Hardpan ❑ Adobe Fill Material-______.___ If yes, type ____________________________ (Plot plan, showing size of lot, location,of system in relation to yells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No. septictankor seepage pit permitted if public sewer is available within 200 feet,J PACKAGE TREATMENT { ]i SEPTIC TANK'[ ] 5ize-�---------------------------------------- Liquid Depth __________- ; r . (Capacity ------------------- Type ------- = ` •__ 1Materia"j� No. Compartments ------ Distance*toynearest: Well --------------------7---__.-_`•----Foundation ---------------------- Prop. Line ------------------------ LEACHING _-------- _:-------- LEACHING LINE [ ) No.�of-,Lines -- -------------------- Length of each line---------------------------- Total Length -------------------------- Vi _------------------ViBox fJ-------_ Type Filter Material ____________________Depth Filter Material _____________ ' j Distance to nearest: Well ----------------------- Foundation _,---_, __-- -__-__.-... Property.Line:-......................... SEEPAGE PIT Depth -------- ---- Diameter -______________ Number _.__-- ___..'_--____ Rock Filled Yes Q No 0 I Water Table Depth - ------------`" ` r r 'I I � tx vii Distance to nearest: Well _.-------------------------------- ------- Foundation --- -- ------------,-Prop..Liner,-__ -----•----- REPAIR/ADDITIOIV�IPrev. Sanitation Permit# `�'- } } -i1 - ---- Dates fr , ) Septic Tank (Specify Requirements) ---- r--- _ y/f��I-�J- ---/��---_----- - ----------- t Disp al Field {Spec y"` qui�ements)J �----' - --------- � ------- ---- - --- - -------------- -------------------------------------------------------------------------------------------------- ---------- w _ 'i " ` : :fes ------------------- J�(Dravv/6isting and required addition on reverse side) E ._,___I hereby certify fhatil have pfepared this application and that the work will be done in accordance with San Joaquin Cou my Oirdinances,State Laws,-and l4ul?es-and-Regulations of the-.Son.Joaquin Local. Health District. Home owner or licen- sed agents signature certifies the following: "I certifythat in the performance of the work for which\t�'is*peermit is issued,-I shall-not employ an p p p y y person in such manner as to become subject to Workman's Compensation laws of California." Signed --- ------------------------ --- - , Owner BY /� Ji ) By If oth tan owner,i 11 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------.-I--0------------------------------------------------------------------------------------ DATE ------ --1-"-4,/�--- ------------ BUILDING PERMIT ISSUED t: - ----- -- --- --------------DATE ADDITIONAL COMMENTS _g��. .6 ,�;¢-- �„5 , ------ ----------------------- ---------------------------- -7� W----- Pt��—-t- ------- ------ ------------------------------ ---------------- - ---------------------------- ------------------------------------------------------------------------------------------- ------------------------------- ---------Cr --- --------- ------------------------ ---------------- --- ------- ------------------------ -- ----- ---- - - - Final Inspection b ____I______________ _ Date _____ __-f__ _-� '---. __ p Y ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M