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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ---- ---- --- ----------------------------- ._.-._� Permit No. <br /> - (Complete in T&licate <br /> -__-__ This Permit Expires 1 Year From Date Issued Date Issued ...-�54 <br /> Application is hereby made 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 NQ 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .tJ----f, �-cS�d------- -4---�=�-1- ----��-4 T-- <br /> -- ---------.N1TCA_ -CENSUS TRACT -------- ------------------ <br /> Owner's Name -----------------DmUlfl------rH1U 'C ..-----------------------------------------=-------------=-----Phone.-- <br /> Address -------------------------------- ----- ------------ City ------------i�{.' --'---------------------------------------.-------- <br /> Contractor's Name - ---------- `------- -------------------------License # --- ---- --------------- Phone --------------------------- <br /> Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other ------------------ ------------------------- <br /> Number of living units:----_1------ Number of bedrooms ----I-------Garbage Grinder --- Lot Size -------:2_14 - t_S_.._-------_--- <br /> Water Supply: Public System and name ----------------------•---------------------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ,Z ,Clay,Loam ❑ <br /> Hardpan ❑ Adobe '❑ Fill Material ------------ If yes, type ------------------------ <br /> (Plot 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 I ] SEPTIC TANK.14 - Size----------------------------------------------- Liquid Depth --------------------:--- 9-' <br /> Capacity Type __PMCa ._- Material---- ! _ No. Compartments ------ ........:.... V <br /> Distance to nearest: Well ----------(_d------------------Foundation -------- ------- Prop. Line __ ------------- <br /> LEACHING <br /> -- -.._..LEACHING LINE [ ] No. of L-ines _-____-Z------------- Length of each line------ ___o6O------ Total Length <br /> 'D' Box ----I------- Type Filter Material --------------------Depth Filter Material ---------------------------------.-•------.- <br /> Distance to nearest: Well .....�,O Foundation ------/d------------- Property Line .--.---�-.-----:---- <br /> SEEPAGE PIT [ ] Depth ------------ ------- Diameter ---------------- Number ---- ------------- Rock Filled Yes :2`� No C] <br /> WaterTable Depth ----------------------------=--- ----Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .-..--------- ........ <br />' REPAIR/ADDITION(Prey. Sanitation Permit# --------.----------------------------------- Date ----------------------------------) <br /> SepticTank {Specify Requirements) ---- --- ---------------------------- ------------------------------------- ---------------------------------------------------------- <br /> Disposal Field (Specify Requirements) ------ ---------------------------------------------------- --------------- ----------------------------•-------------- <br /> ------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------------------I------------- ---------- <br /> ------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <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 licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Wor anis ompensation laws of California." <br /> Signed ----- ------------=- - - ------------- ------ Owner <br /> BY ----------- Title <br /> (If other than ner) - . <br /> FOR PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- ---------------------------------------------- DATE ------- _C------- <br /> BUILDWG PERMIT ISSUED ------------------------------------ ------------------ -------------------------------------------- ---DATE -------------•----------------------------- <br /> ADDITIONALCOMMENTS ------------------------------------------ ------------------------------------- -- ------------------------------------------- ---------------•----------- <br /> --------------------------------------- -------------------------------------- <br /> ---------------------------------- -------------------------- ------------------------------------------ ------------------------------•- <br /> ---------------------------------- ' <br /> Final Inspection by: ------ _----------- -- --------------- ---------- ----- - ------Date - r <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />