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i <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -------------------- ------------------ ------- -3 t(Complete in Triplicate) Permit No. 43 <br /> ------------------------------------------------=-``-- <br /> __________-�IThis Permit Expires ] Year From Date Issued Date Issued <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 No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LO TION ' ------------ ---------------CENSUS TRACT -------------------------- <br /> Owner's Name I-- -- - -- - - ----- C1-----------------------------------------Phone ----- -._.- <br /> fe <br /> Address ---- city --•-••. <br /> Contractor's Name ---- •- '�.,.�,- -------.License # -� 3;'n-_ Phone -------------------•- <br /> ---- - - - -------- <br /> Installation will serve: Residence �(Apartment House❑ Commercial :❑Trailer Court ;❑ <br /> Motel ❑Other -- ------------------------------------------ <br /> Number <br /> ---------------------------------------Number of living units:--_---- --- Number of-bedrooms ---._Garbage Grinder ------------ Lot Size ---------------------------_---_-._--__--_ <br /> Water Supply: Public System and name -----------(sem _ ❑ <br /> -- - -- - -- - -- - - - - ------------•------------------------------------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay-F] feat❑ Sandy LoamClay loam <br /> Hardpan ❑ Adobe.❑ Fill Material ------------ If yes, type -_------------------------- <br /> (Plot plan, showing size;lof 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:[ ] Size-----------------------------------.------------ Liquid Depth -_--__-____--_---_ vi <br /> ,_-___ <br /> Capacity ---------------- --- Type -------------------- Material---------------------- No. Compartments ------ ---------- �+ <br /> (Distance to nearest: Well -`- ------------- ------Foundation ---------------------- Prop. Line -----.--_- :-------- 6 <br /> LEACHING LINE No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------------------- <br /> !I <br /> V Box ------------ Type Filter Material --------------------Depth Filter Material ----------------------_____----_-_--._------ <br /> .II <br /> Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---___--------_-.----__. <br /> q <br /> SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No QCs <br /> Wi <br /> ater Table Depth ------------------------------------------------Rock Sze -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _...---_._______------ <br /> REPAIRfADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------1 <br /> Septic Tank (Specify Relquirements) -------------------------------- --- ------------------------------ -------------------------- <br /> Dispasal Field (S�Ciff:' Requirements) --_-{ _ -_- __--�� ----- - ----- <br /> _9090- <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 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--- .F <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 Workman' Compensation (laws of California." <br /> Signed ---------------------------- ------ ------'------------------ ---- - -- --------- Owner <br /> BY :I - c _ Title 1�- i�i <br /> (if other than owner) <br /> 1 FOR .DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED��.BY ----- °--- --- ----------------------------- - ---------------------- <br /> ----------------------- DATE --.5'0 ,'72---------------- <br /> BUILDING PERMIT 1SSUEb ---- _- _-- _---------DATE -------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------------------------------------------------------------------------- ------------------•- ------ <br /> i <br /> ------------------------------ -------- <br /> Ql� <br /> -------------------- ------------ --------- ---- --------- ----------- <br /> 73 <br /> Final Inspection by, - ---- ----------- ---- -----------------•--------------------- Date --------- �- --- -------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'66 Rev. 5M <br />